Inspection on 23/01/09 for Lowena Hostel

This inspection was carried out on 23rd January 2009.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lowena Hostel 22/01/07

Lowena Hostel 28/02/06

Lowena Hostel 29/06/05

Lowena Hostel 01/12/04

Lowena Hostel 15/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lowena Hostel Mitchell Hill Truro Cornwall TR1 1JX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 2 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Lowena Hostel Mitchell Hill Truro Cornwall TR1 1JX 01872270013 01872241992 jjackson@cornwall.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cornwall County Council Name of registered manager (if applicable) Ms Julia Jackson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Lowena is a care home for adults with learning disabilities providing a short break service. Over 100 families are currently supported by the service. The home is located close to the centre of the City of Truro. The home is purpose built, divided into four residential units, linked together by a central entertainments and activities room. One unit accommodates children, which is inspected separately. There is a sensory garden and brightly decorated courtyards for guests to enjoy. Each part of the home has its own kitchen, dining room and lounge. There is sufficient car parking to the front of the property. A copy of the last CSCI inspection report is available in the reception area, along with other useful information much of which is also in easy read fromat. The level of government benefits received by the guest determines the fees payable, and there is no fixed fee per night of stay. There are additional charges e.g. for hairdressing and newspapers etc. 25 Over 65 0 care home 25 Care Homes for Adults (18-65 years) Page 4 of 30 Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place from 10.45 am to 2.45pm on 23rd January 2009. The inspection was conducted with the manager. A tour of the home was carried out and people who stay at the home and support staff were spoken to and observed during the inspection. The provider submitted an Annual Quality Assurance Assessment (AQAA) prior to the inspection (this is a detailed self audit that is required to be completed annually). Completed surveys were received from a number of guests prior to the inspection. Information taken from them and the AQAA are reflected throughout this report. A variety of records and documents stored at the office were also examined. Care Homes for Adults (18-65 years) Page 6 of 30 Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service (and their representatives) have comprehensive information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they stay at Lowena. Evidence: There is a clear pre admission assessment procedure in place that is completed prior to inviting a guest to come and stay at Lowena. This includes a meeting of a panel of professionals involved in an individuals care to decide if Lowena is an appropriate setting for them and the frequency and length of stay that is possible. A key worker is appointed and goes to visit the prospective guest in their current environment to assess their level of need. The manager showed the inspector the Statement of Purpose that has been developed Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: with the guests and contains practical information about the people who work at Lowena and what the service can offer and pictorial representation of activities that the guests are involved with in and outside Lowena. A copy is given to prospective guests by the key worker when the pre admission visit is carried out. It is available in different formats. Completed Service user Surveys indicated that they had enough information about Lowena before choosing to stay there. There is a copy of the previous CSCI inspection report displayed in the reception area Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be fully met. Guests are involved in a number of decisions made at Lowena meaning that they contribute to the overall outcomes for people. Evidence: The 3 support plans examined had a lot of information about the individual and their abilities and lifestyle choices. They had been regularly evaluated and were up to date. They are constructed in a style that the guest can be involved with the review and updating of it but also that support staff can write day to day information about the welfare of the guest during their stay. It is used each time a guest comes to stay. One guest spoken to said they understood what the support plan was and that the staff use it to write information in. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Guests are asked to bring enough money with them for their stay. The manager demonstrated the system in place to manage peoples money this includes recording expenditure and keeping receipts as evidence. The manager described how guests are involved in the day to day running of the home. They are consulted and involved when any changes are being bought in for example the guests were consulted about changing the names of the wings and then voted on the names they wanted. They are also involved with the interviewing and selection of staff. One guest has written some interview questions and sample answers. people who cannot be involved in interviewing prospective staff are able to meet them during the interview day and are asked for opinions of them once they have met them. The manager said that some of the guests are involved with amending the Service Users Guide (Guests Guide) to ensure it reflects what the service does and is in a style that many of the guests can understand. The home has policies and procedures about confidentiality and records seen were accurate and kept safely. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within Lowena and the local community mean that people have opportunities to participate in stimulating and motivating activities. Peoples rights are respected and people are encouraged to take appropriate responsibility in their daily lives. Meals provided by Lowena ensure that the guests have a healthy and varied diet. Evidence: Completed Service user Surveys and staff spoken to during the inspection were able to say how guests spend their time at Lowena, what they do outside the home and what they like to do as individuals. Most of the guests are out during the day in the week and are able to decide how they spend their days when they are staying for the Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: weekend. They all have local links and are included in the local community when they are out and about. The staffing levels vary according the number of guests who are staying and allow for people to be accompanied when going out in the evening or at weekends. There is a central activities/games area where people can socialise during the evening and at weekends. Each unit has communal space for people to eat and relax. A number of rooms have wall mounted TVs (purchased following feedback for quality assurance surveys) and and radios/CD players are provided in most rooms. People are not encouraged to bring their own in as it is a short break service and because of the throughput of people portable electrical testing of each item would be difficult to manage. The manager said the staff discuss with the guests about what they like to do and try to vary the opportunities people have whilst staying at Lowena. One completed Service user Survey said that there are various excursions over the weekend and they can choose whether they go or not. Visitors are welcomed at all times. Guests have breakfast before they leave for their individual activities, where lunch is often provided. The main meal at Lowena is in the evening and the manager said that since the housekeeper post has been developed the meals have improved. The guest can eat where they like but each unit has a dining area where they are encouraged to come and eat. Staff are available throughout mealtimes to offer help and support as required. The guests have access to all parts of the home and gardens and are encouraged to make full use of the facilities. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and support and management of medicines are of a good standard meaning peoples needs are met. Evidence: The manager and staff spoken to said that guests can go to bed when they want to, but realise they have to get up at a certain time in order to attend education or day centre activities during the week. Support plans seen included individual records that detailed guests preferred routines and likes and dislikes. Personal support is provided in private and a number of adaptations and assisted toilets and bathrooms seen around the home ensure guests are given the support they require with the appropriate equipment. As Lowena is a short break service they maintain partnerships with advocates, family and relevant professionals outside the home to ensure the ongoing support of the guest and are involved in continued monitoring and reviews. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Medications are bought in by the guest for the time they are stopping. What they bring with them is documented on a medication administration record and the staff then ensure the guests have their medication at the right times. The medication policy seen (which is in the guide given to everybody before they stay at Lowena) states clearly that the staff do not give out of date or medicines prescribed for somebody else. Staff files examined show that a number of staff have had training in medicines management. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. All staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: There is a formal complaints procedure in place which is in the Statement of Purpose and the Guest Guide, leaflets are also available in the foyer some being in easy read format. Support plans seen had information in a format suitable to the person concerned about how to make a complaint or discuss a concern if necessary. The Commission have received no concerns or complaints about this service. The completed AQAA stated that the home has had 3 complaints in the last 12 months that have been dealt with via the complaints procedure, 2 of these were upheld. During discussion with the manager it was clear that there is an awareness of adult protection/safeguarding procedures and people would know who to contact if necessary. Lowena has policies and procedures around complaints and protection that are available to staff at all times. The manager said that all staff have training on safeguarding adults, this was confirmed by certificates seen in staff files examined. The residents visit day centres and have contact with outside agencies to whom they are able to talk if they have any concerns that cannot be shared with staff at the home. Care Homes for Adults (18-65 years) Page 19 of 30 Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing refurbishment and redecoration means people have a comfortable and safe environment in which to stay. Evidence: Lowena is owned and managed by Cornwall County Council (www.cornwall.gov.uk click on Department of Adult Social Care to access information about short break services. It is purpose built and all on one level. It is near to the centre of Truro and local facilities. On the day of the inspection the home was clean and tidy. The individual rooms seen were furnished and decorated appropriately (they are not individually personalised as guests only stay for short breaks), most rooms had a TV and a CD radio also (guests are asked not to bring their own in as portable electical testing of so many items would be difficult to manage). There are a number of assisted bathrooms and toilets throughout the home. Each wing has a communal area where people can relax and eat their meals, there is also a general communal area where guests can meet to play games, watch TV or just mix with others. Outside space includes a sensory garden and 2 enclosed courtyards with seating that guests enjoy in the good weather. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The guests were asked to choose some names for the wings and then a vote took place to pick the actual ones which are now in place giving the house a more homely feel. Ongoing repairs and maintenance is done by Cornwall County Council, the staff decorate individual rooms as required with contemporary colours and designs. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The robust recruitment procedure means that people who stay at Lowena are being looked after by appropriate staff and their welfare is not at risk. Evidence: Cornwall County Council have a robust recruitment procedure. Included in the staff files seen were a CRB check (or the CRB check number), 2 written references, previous employment history, job description and a contract of employment. There was also evidence of regular supervision sessions (one to one) and appraisals having taken place. The AQAA states that staff who have supervisory responsibilities have undertaken supervisory skills training. The manager said that guests take part in the interview process (some questions and sample answers developed by a guest were seen during the inspection) and their feedback is used when making a decision. Guests who want to meet prospective staff members are encouraged to do so during the interview day and are asked for feedback before a decision is made. The manager said that a variety of training is offered to staff this includes first aid, Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: manual handling, fire safety, food hygiene and other training appropriate to the conditions of the current guests. This was confirmed by copies of certificates seen in staff files examined. The AQAA states that 30 staff have undergone training in prevention and control of infection and 39 people have undergone training in safe food handling. A learning and development proforma has been introduced, this consists of a form the staff have to complete to include all the qualifications they have and courses they have attended. They need to keep this updated so that Lowena has up to date information about who has done what and when statutory training is due to be completed. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 systems and procedures in place are designed to meet the needs of the service as they strive to improve the service the home offers to the people that stay there. The attitude to health and safety shown by the providers, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: Since the last inspection (January 2007) the home has notified the Commission of any incidences that they are required to report. The current manager has worked at Lowena for many years and has 30 year experience of working in a care environment. She is a qualified social worker and has an NVQ level 4 in management and a certificate in management. She attends regular training and updates to ensure she is up to date with new guidance and best practice recommendations. Lowena has a formal quality assurance system in place which is based on seeking the views of those that live in the home and other people who visit the home in a Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: professional capacity. The manager said that 12 flat screen TVs were bought for individual rooms following feedback from the guests. A completed Annual Quality Assurance Assessment was returned to the Commission prior to the inspection as required (December 2008). It was very detailed and included all the information the Commission asks for. A representative of the provider carries out a monthly visit to the home to speak with guests and staff, look at the environment and to review examples of documentation in use. A report is prepared and any actions required are documented and discussed during staff meetings and management meetings (minutes of a number of meetings were seen during the insepction). the AQAA states that staff and guests are encouraged to be involved in developing the service by discussing ideas and suggestions. All records seen were up to date, well constructed and stored securely. Staff spoken to said that guests are encouraged to be involved in their support plans and help to update them if able. Emails and cards from a number of families of guests were seen that were appreciative of the fact they had been asked to help develop and review their relatives support plan. In order to ensure safe working practices training is provided in manual handling, fire safety, first aid, risk assessments and food hygiene for example. The manager has records of risk assessments that are carried out for the house. Individual risk assessments are kept in their support plans. These are updated as required and available to staff at all times. The accident books seen was completed appropriately and is available to all staff to record incidences as necessary. The induction programme covers aspects of health and safety relevant to the current client group (when they are in and out of the house), the staff group and Lowena including security of the premises, safe storage of hazardous substances, safeguarding and risk assessments. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 12, 13, 19 All staff must have a POVA First check before they commence employment. Until staff receive a satisfactory CRB disclosure they must be appropriately supervised. All staff must have a POVA First check before they commence employment. Until staff receive a satisfactory CRB disclosure they must be appropriately supervised. 01/03/2007 2 34 12, 13, 19 01/03/2007 3 35 18 The registered persons must 01/05/2007 provide appropriate training for staff: As required by law (i.e. manual handling, infection control, food hygiene, first aid, fire safety) To meet the needs of individual service users (e.g. epilepsy) All staff who handle medication must receive external training by a suitably qualified person (e.g. pharmacist) Suitable records of training must be maintained (e.g. certificates of attendance of training courses) Previous timescale of 01/09/2006 not met Second Care Homes for Adults (18-65 years) Page 27 of 30 Notification 4 37 9 The registered provider must 01/03/2007 submit an application for the temporary manager due to the long-term sickness of the registered manager. Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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