Care Home: Alexandra Park

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What the care home does well The home carries out thorough assessments about people`s needs prior to admission. The care plans are comprehensive and contain clear guidelines for the staff on how care and support should be delivered. The staff team are committed to ensuring the health, rights, welfare and safety of the people living in the home. There are systems in place to review quality, which ensures consistent good care practices. Comprehensive policies and procedures are in place and reviewed on a regular basis. The management are committed to staff training and development to help make sure the individual needs of the people living in the home are met. The health care needs of people living in the home are very well met and recorded. The menus are varied and nutritious and alternatives are always available. People are supported to keep in touch with family and friends. Visitors are always welcome in the home. The staff support people to access facilities in the local community and offer them new experiences. What has improved since the last inspection? A contractor has been booked to tarmac the public pathways around the premises to make them safer. The soak-away pond has been fenced off to help ensure people`s safety. The dip by the gateway of the pedestrian pathway has been repaired to help prevent people falling. Some parts of the site were prone to flooding. Work has been completed to the drainage system to prevent this happening. Mandatory health and safety training for the staff is now up to date. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 What the care home could do better: The garden areas outside some bungalows are unkempt and require attention. The communal grounds are in need of landscaping so they look more attractive and can be used by people living in the home. All formal supervision sessions for staff need to be brought up to date. Key inspection report CARE HOME ADULTS 18-65 Alexandra Park Alexandra Way Newbiggin by the Sea Northumberland NE64 6JW Lead Inspector Anne Brown Key Unannounced Inspection 7th July 2009 09:00 Alexandra Park DS0000071701.V376375.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. Alexandra Park DS0000071701.V376375.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 Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Park Address Alexandra Way Newbiggin by the Sea Northumberland NE64 6JW 01670 812615 01670 523631 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) Acaena Limited Care Home 32 Category(ies) of Learning disability (32), Mental disorder, registration, with number excluding learning disability or dementia (32), of places Physical disability (32) Alexandra Park DS0000071701.V376375.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 categories: Learning Disability - Code LD, maximum number of places 32 Physical Disability, Code PD, maximum number of places 32 Mental Disorder, excluding learning disability or dementia, Code MD maximum number of places 32 The maximum number of service users who can be accommodated is: 32 7th August 2008 2. Date of last inspection Brief Description of the Service: Alexandra Park is a custom-designed and built facility offering services for adults with autistic spectrum disorder or Asperger’s Syndrome. It comprises 28 single occupancy bungalows and a four bedroomed house. Support is provided over twenty four hours by staff who are trained by Alexandra Park’s Consultant Specialist in autism. There is a resource centre on site where training, parent coaching, career teaching, social activity and administration will be carried out. The home is situated in a residential area of Newbiggin by the Sea. It is within walking distance of the sea front, shops and bus services. Alexandra Park does not provide nursing care or intermediate care. However, where people require nursing intervention, suitable arrangements are made with GP practices so community nurses can ensure needs are met. Information about the home is readily available. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 5 The weekly fees are assessed according to each person’s individual needs. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star – good service. This means that the people who may use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out Before the visit: We looked at: • • • Information we have received since the last inspection on 7th August 2008. Any changes to how the home is run. The provider’s view of how well they will care for people. The visit • An unannounced visit was made on 7th July 2009 During the visit we: • • • • • • Talked to the manager and staff on duty. Looked at assessment information about the people who may use the service and how well their needs are met. Looked at some policies and procedures. Looked at staff training programmes. Looked at the home’s recruitment and selection procedures. Looked around the premises to make sure they were clean, safe and comfortable. We told the manager of the home what we found. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? A contractor has been booked to tarmac the public pathways around the premises to make them safer. The soak-away pond has been fenced off to help ensure people’s safety. The dip by the gateway of the pedestrian pathway has been repaired to help prevent people falling. Some parts of the site were prone to flooding. Work has been completed to the drainage system to prevent this happening. Mandatory health and safety training for the staff is now up to date. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 8 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. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 9 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 Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 10 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 and 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. Good information is available for people who are considering using the service and needs are fully assessed before anyone is admitted to the home. This helps ensure their individual needs can be met. EVIDENCE: The statement of purpose and service user guide both contain the full range of information required. This helps people decide if the home is able to meet their needs. There is one person living in the home at the present time. A thorough preadmission assessment had been carried out. This included obtaining a Care Management Assessment and information was sought from carers, relatives and relevant health care professionals. A copy was available on the case file so staff can refer to it to help ensure individual needs are met. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 11 People can spend time in the home and admissions are made on a gradual basis. This helps people to make an informed decision on whether the home is suitable for them prior to deciding to move in permanently. The person living in the home has a signed contract outlining the terms and conditions of residency. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 12 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 and 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. The care plans give staff very good information about the needs of the people living in the home and guidelines on how these needs must be met. This helps to ensure effective and consistent care is provided. EVIDENCE: The care plan sets out detailed care needs of the person living in the home and action plans are formulated to address them. The staff record information on a daily monitoring form which is evaluated monthly to help ensure any changing needs are fully met. Reviews are held on a regular basis, or when it is necessary and all interested parties are invited to attend, with the permission of the person living in the home. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 13 The case files contain comprehensive guidelines from health care professionals to help staff meet the needs of the person living in the home. The manager intends to complete a personal planning book for everyone who moves into the home. This includes personal details of the person, people in their lives, the story so far, their life now, dreams, hopes and wishes. The staff support people to take calculated risks to enhance their lifestyles. Risk assessments are in place and these are reviewed regularly. An agreement to ‘limit’ choices has been discussed with family members and is fully documented. The staff encourage the person living in the home to make choices and decisions. Due to poor verbal communication the staff observe gestures and body language to interpret needs and wishes wherever possible. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 14 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: 11, 12, 13, 14, 15, 16 and 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. The person living in the home is encouraged to mix with people in the local community and is well supported to participate in activities of their choice. EVIDENCE: The person living in the home is well supported by the staff to choose what activities they wish to participate in. This information is recorded in the daily reports. The person living in the home enjoys going for walks, swimming, bowling, visiting cafes and pubs. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 15 The staff have researched the local area and what facilities are on offer. These are available in photographic form so informed choices and guidance can be offered. Facilities are also available on the complex. These include a computer room and art room. The staff support the person to keep in touch with relatives. Visitors are made welcome at any time. There are four weekly menus in place and an alternative is always available. The person living in the home accompanies the staff to do the food shopping on a regular basis. Special diets can be catered for and advice would be sought from a dietician if necessary. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 16 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 and 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 person living in the home is given personal support when they need it and staff monitor and promote their health to maintain their well-being. EVIDENCE: The case file contains a section on health which includes information about physical, social, emotional and psychological needs. The support plans are regularly reviewed and the staff read and sign to say they have understood and agreed to follow these. The health and welfare of the person living in the home is constantly monitored. If there are any concerns appropriate action is taken. The manager said they were awaiting an appointment being made with a consultant at the present time. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 17 Details of health checks, hospital appointments, visits to GP, dentist, optician etc. are recorded on the case file. There are clear guidelines to inform the staff how each person’s care and personal support should be delivered. A document was in the case file known as ‘Hospital Passport’. This provides important information if someone needs to be admitted to hospital. It also gives details about how people prefer to be cared for. The staff confirmed that they had been provided with specialist training to meet the needs of the person living in the home. The medication records were up to date and appropriately signed. The medication is counted on a daily basis and a monthly audit is carried out by the manager. Competency assessments are carried out for all staff annually. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 18 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 and 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. There is an appropriate system for dealing with complaints and training in safeguarding vulnerable adults has been provided for the staff. This helps to protect people from abuse. EVIDENCE: The home has an appropriate procedure for dealing with complaints. A complaints book is maintained to record complaints and the outcome of the investigation. No complaints have been received. The complaints procedure is displayed in the reception area and a copy is provided to all prospective residents. There is a whistle blowing procedure in place. The staff said were confident to use this if they observed any bad practice. The staff are given training on safeguarding vulnerable adults and various forms of abuse. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 19 There are clear policies and procedures on safeguarding vulnerable adults. These are readily accessible in the home and adhere to the guidance in “No Secrets”. The staff are also trained on minimising confrontation techniques and nonviolent, physical crisis intervention break away techniques. The person living in the home cannot manage their own finances. Their personal allowance is held by the home for safe keeping. All transactions are fully recorded. Receipts are kept for all purchases made and two staff signatures are maintained. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 20 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, 27, 28 and 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. All occupied areas of the home are comfortable, well furnished and decorated and provide people with a pleasant place to live. EVIDENCE: The person living in the home has their own one bedroomed bungalow. This is well furnished and decorated. The sleep in staff use the bungalow next door. At present the other bungalows and the lodge at unoccupied. All communal areas are well decorated and maintained. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 21 The gardens at the bungalow which is occupied are well maintained. Other areas around the site have been neglected and are in need of attention. The manager stated that maintenance staff have been offered extra hours to address this problem. Work has been taking place to rectify drainage problems on the site. The manager said that the communal gardens were to be landscaped in the near future. The soak away area is now fenced off and the manager plans to plant hedges around this to make it more attractive. She also confirmed that work is due to commence in the next few days to tarmac the pathways around the site. Work has commenced in the lodge to create an en suite toilet to one bedroom and to convert a communal shower room into a laundry. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 22 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 and 36. 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. There are sufficient staff employed in the home who are well trained to meet the individual needs of the person who lives there. EVIDENCE: The home currently employs a manager, team leader, three senior support workers, six support workers, one administrator, one maintenance manager, one handyman and one domestic. The number of support workers will be increased when more people are admitted to the home. The person living in the home is cared for by two support workers during the day. Overnight there is one waking night staff and one sleep in on duty. The home operates a robust recruitment and selection policy. There was evidence on the staff files to show that Criminal Record Bureau checks and two Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 23 written references are received prior to staff being employed. The staff files were well organised so that information is easily accessible. There are training programmes in place to help ensure staff receive mandatory health and safety training. Specialist training is also provided to meet individual needs. The manager confirmed that five staff hold an National Vocational Qualification (NVQ) Level 2. The remaining staff have been enrolled to undergo this training and two staff are doing NVQ Level 3. A member of staff confirmed that the training provided is very good and met their needs. They were well aware of the needs of the person living in the home. Formal supervision sessions had taken place and the notes were recorded. Some were out of date but the manager said these were to take place in the near future. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 24 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, 40, 41 and 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. The home is well run and is managed for the benefit of the person living there and their health and safety is promoted. EVIDENCE: The manager is experienced in managing care homes and holds appropriate qualifications. She is committed to providing good care and putting the needs of the people living in the home first. She promotes an ethos amongst staff of Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 25 involving them in the decision making process. A member of staff on duty said the manager is supportive and very approachable. Staff Meetings are held on a regular basis so people can express their views and suggestions. The minutes were well recorded. There is a quality monitoring and assurance system in place and the views of relatives are sought. There is also a survey for people living in the home to complete about how well the staff perform and how things could be improved. Senior management visit the home on a monthly basis and produce a written report. This helps to ensure that standards are maintained. The manager maintains a set of files containing evidence of how the home meets each National Minimum Standard. Health and safety meetings are held monthly and the members inspect the premises for any safety hazards. Comprehensive health and safety policies and procedures were in place. Health and safety checks are carried out by the maintenance person on a regular basis. The records showed that fire drills are carried out and fire equipment is checked on a regular basis. The person living in the home has a personal emergency evacuation plan. There is also a ‘fire bag’ which contains useful items which may be needed if people had to evacuate the building. All accidents are recorded and analysed on a monthly basis and appropriate action is taken if necessary. The home has a management quality system in place to help ensure good standards continue to be met. Systems are in place for the review and development of the service. Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 26 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 X 27 3 28 2 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 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 3 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 27 Alexandra Park DS0000071701.V376375.R01.S.doc NO 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 YA28 Good Practice Recommendations The communal grounds should be landscaped so they look more attractive and can be used by people living in the home. The overgrown garden areas outside some bungalows need to be tidied up. Formal staff supervision sessions should be brought up to date. 2. YA36 Alexandra Park DS0000071701.V376375.R01.S.doc Version 5.2 Page 28 Care Quality Commission North East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@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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