Care Home: Queens Park

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What the care home does well Queens Park provides a high standard of accommodation to the people who live there. The style and decor is contemporary and all areas spacious and wheelchair-friendly. Corridors and doorways are wide for ease of movement and there is a passenger lift for access to the first floor. When we arrived one of the people who live there told us, `This is a happy home.` Service users are encouraged to make choices about all aspects of their lives. One of them said, `You can have what you want here and you can do what you want. Nobody tells me what to do but the staff help me if I need them to.` The Owner said, `Everything here is individual to each service user, when they go out, where they goout, what they eat, and how they bath. They decide, not us.` The atmosphere in the home was lively and friendly. The people who live there congregated round the large dining room table where we joined them for a chat. Staff were playing cards with one service user and giving another a makeover and manicure. In the adjacent kitchen lunch was being prepared and service users were taking an interest in what they were having. The staff on duty were caring and helpful. We saw they got on well with the people who live in the home. They were observed working closely with them, helping them to make choices, and accompanying them out into the community. What has improved since the last inspection? Not applicable as this is a newly registered home. What the care home could do better: No areas in need of improvement were identified at this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Queens Park 15 Queens Park Way Eyres Monsell Leicester LE2 9RQ The quality rating for this care home is: three star excellent 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: Kim Cowley Date: 1 5 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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: Queens Park 15 Queens Park Way Eyres Monsell Leicester LE2 9RQ 07730403439 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chestnuts (Arnesby) Limited Name of registered manager (if applicable) Beverley Hart Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 care home 12 learning disability Additional conditions: The registered person may provide the following categories 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 The maximum number of service users who can be accommodated is 12 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Queens Park is a newlyregistered care home for up to 12 younger adults with learning disabiilities. It is situated in a residential area on the outskirts of Leicester. The premises are detached and on two floors, with a passenger lift. There are twelve ensuite bedrooms, two lounges, a dining room, sensory relaxation room, and sensory bathroom. At the rear of the home is a safe and secluded garden. Fees range from £940 to £1850 per week. Further information about the home is available from the Manager. 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: three star excellent 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 Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: What the care home does well Queens Park provides a high standard of accommodation to the people who live there. The style and decor is contemporary and all areas spacious and wheelchair-friendly. Corridors and doorways are wide for ease of movement and there is a passenger lift for access to the first floor. When we arrived one of the people who live there told us, This is a happy home. Service users are encouraged to make choices about all aspects of their lives. One of them said, You can have what you want here and you can do what you want. Nobody tells me what to do but the staff help me if I need them to. The Owner said, Everything here is individual to each service user, when they go out, where they go Care Homes for Adults (18-65 years) Page 7 of 30 out, what they eat, and how they bath. They decide, not us. The atmosphere in the home was lively and friendly. The people who live there congregated round the large dining room table where we joined them for a chat. Staff were playing cards with one service user and giving another a makeover and manicure. In the adjacent kitchen lunch was being prepared and service users were taking an interest in what they were having. The staff on duty were caring and helpful. We saw they got on well with the people who live in the home. They were observed working closely with them, helping them to make choices, and accompanying them out into the community. Care Homes for Adults (18-65 years) Page 8 of 30 What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 9 of 30 If you want to speak to the inspector please contact: Kim Cowley CSCI CPC 1 Capital Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 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 10 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 11 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 . Quality in this outcome area is good. People who want to come to the home have their needs assessed to ensure it is suitable for them. This judgement has been made using available evidence including a visit to this service. Standard 2 was inspected. Evidence: People who want to live at Queens Park first have a written assessment to see if the home is suitable for them. The Manager completes this, taking into account their views, and the views of their families and friends. Health and social care staff who are involved in their care are also consulted. This helps to ensure that the home will be able to meet their needs if they decide to live there. They are then invited to visit the home as many times as they like, staying overnight if they wish, until they are ready to move in. One service user we case tracked came to the home six times before he made the decision it was right for him. He visited at different times of the day so he could get a fuller pictures of life at the home. During Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: this time staff were able to do a series of assessments and put care plans in place ready for when he moved in. Care Homes for Adults (18-65 years) Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is excellent. Detailed care plans help staff to identify and meet the needs of the people who live in the home. This judgement has been made using available evidence including a visit to this service. Standards 6, 7, and 9 were inspected. Evidence: All the people who live in the home have care plans that cover their health, personal and social needs, likes/dislikes, and preferred lifestyles. Those we looked at were of an excellent standard. They were person centred and written from the point of view of the service user. For example one care plan for bathing included the following, I like to have a bath in the sensory bathroom where the lights are on and music is playing on the stereo. I like to smell nice and look good. Those who live at Queens Park are encouraged to make choices about all aspects of their lives. One of them told us, You can have what you want here and you can do Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: what you want. Nobody tells me what to do but the staff help me if I need them to. The Owner said, Everything here is individual to each service user, when they go out, where they go out, what they eat, and how they bath. They decide, not us. One of the people who live in the home is moving towards independent living and this is reflected in their care plans. This helps to ensure that everyone involved in their care knows what their goals are and can help them achieve them. The people who live in the home are helped to take responsible risks, for example using the homes kitchen. Staff only intervene if there are serious concerns about their well being. This will help them to increase their independence and decision making skills, while at the same time remaining safe. Care Homes for Adults (18-65 years) Page 15 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 . Quality in this outcome area is good. Daily living and social activities enable the people who live in the home to lead full lives and grow in independence. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16, and 17 were inspected. Evidence: The atmosphere in the home was lively and friendly. The people who live there congregated round the large dining room table where we joined them for a chat. Staff were playing cards with one service user and giving another a makeover and manicure. Other service users were coming and going to and from various activities in the wider community. In the adjacent kitchen lunch was being prepared and service users were taking an interest in what they were having. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: All the people who live in the home have their own programme of recreational, educational, and vocational activities, depending on their needs and what they want to achieve. In discussions the people who live in the home talked to us about the sort of things they like to do, and how staff help them get out into the community. Comments included We went to the pub for dinner and I had fish and chips. The staff take us out. I like walking in the park. I like baking here. The staff help me. I went to a posh cafe for this morning. I went with a member of staff who looks after me. Staff told us that most of the people who live in the home like a routine or they can get anxious, but some like to do things on the spur of the moment as well and this is catered for. Staff support the people who live in the home with their friendships and relationships, providing guidance and support. Staff take services users out to see their families and sometimes collect family members who dont have transport and bring them to Queens Park. One service user told us, One of the staff member took me to see my dad and I phone my relatives from here. Another said, My family visit. We go in the lounge. They like it here. Lots of other families come here as well. Care staff take it in turns to cook, helped by some of the people who live in the home. Menus are planned on a group basis, and staff know each service users likes and dislikes. Three of the people who live in the home are able to prepare their own meals with staff support and they are encouraged to do this. We talked to service users about the food and they made the following comments; In the morning I have coco-pops and coffee and then I go upstairs for a shower. I have porridge every morning. I like the food. I like it when we have chicken. I like a boiled egg in the morning. Weve got a nice tea tonight. I know what it is. Two of the people who live in the home have had the involvement of a dietitian to help ensure their diet is suitable for their needs. Care Homes for Adults (18-65 years) Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is excellent. The people who live in the home have their personal and health care needs met in the way they want by staff in the home. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 and 20 were inspected. Evidence: The people who live in the home are encouraged to be as independent as possible and are supported to care for themselves. Where necessary, help and guidance is offered in a sensitive and flexible manner. Care plans provide the information staff need to care for service users and make them aware of their likes and dislikes. Staff are in the process of getting an easy chair on wheels for one service user so she can be more comfortable during the day time. Records showed that the people who live in the home use local health care services, for example GPs, opticians and dentists. All have Health Action Plans in place which help staff to ensure their health care needs are met. We talked to the people who live in the home about how their health care needs were met. One told us, I have my feet Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: massaged and my nails done, and another said, I went to the dentist and he said I have to use an electric toothbrush. Records showed that where necessary physiotherapists work with service users to help them increase their mobility. Medication is kept securely in the homes treatment room. All staff are trained by the homes pharmacist to administer medication, but only seniors give it out. We discussed the storage of controlled drugs with the Owner. At present there are none in the home and it was agreed that if they were prescribed staff would check with the homes pharmacist to ensure the present storage facilities were suitable. Care Homes for Adults (18-65 years) Page 19 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 . Quality in this outcome area is good. Staff know how to safeguard the people who live in the home and help them express any concerns they might have. This judgement has been made using available evidence including a visit to this service. Standards 22 and 23 were inspected. Evidence: There is a pictorial complaints procedure for the people who live in the home. Each of them has a copy of this and it is also displayed in the home. We talked to one service user about what he would do if he was unhappy about something. He said, If Im not happy I tell the staff. We also talked to staff about how they would advocate for people who are unable to use the complaints procedures due to their communication difficulties. They told us how they could tell if certain service users appeared unhappy, and showed a good understanding of their responsibilities to safeguard the people who live in the home. There have been no complaints since the home opened. Safeguarding policies and procedures in place and available in the staff room. Safeguarding training is covered in the homes induction and staff are booked to attend an external course on it in 2009. We discussed safeguarding with two staff member, putting various scenarios to them. Both were knowledgeable about the Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: safeguarding process and knew exactly what to do if they become concerned about a service users well being. Care Homes for Adults (18-65 years) Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is excellent. The home is community-based, comfortable, and well maintained. This judgement has been made using available evidence including a visit to this service. Standards 24 and 30 were inspected. Evidence: Queens Park provides a high standard of accommodation to the people who live there. Previously a council care home, the premises have been completely refurbished throughout. The style and decor is contemporary and all areas spacious and wheelchair-friendly. Corridors and doorways are wide for ease of movement and there is a passenger lift for access to the first floor. Downstairs there are two lounges, a dining room, and a large kitchen which is accessible to wheelchair-users with lowered work surfaces so they can prepare food in comfort. There are three bedrooms on the ground floor with French windows leading in the gardens. The rest of the bedrooms are on the first floor, along with a wellequipped sensory room. The home has two bathrooms, one upstairs and one downstairs. One of these is a sensory bathroom where music is played and a projector casts moving images on the wall Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: On the first floor are the rest of the bedrooms. A vacant one is current being used as lounge/computer/TV room at the request of a service user. Most of the bedrooms have tracking for ceiling hoists and some have electronic beds which can be easily positioned. All have large ensuites, TVs, call bells, internet access, and telephone points. One of the people who live in the home showed us his bedroom, using his own key to get in. This, and another two bedrooms we looked at, were personalised and individual to their occupants. At the rear of the home are wheelchair-accessible landscaped gardens overlooked by a terrace. There is a smoking shelter at the side of the home for the use of the people who live in the home. Care staff and a part-time cleaner are responsible for keeping the home clean. All areas inspected were clean, tidy and fresh. Care Homes for Adults (18-65 years) Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is excellent. The people who live in the home have their needs met by friendly and professional staff. This judgement has been made using available evidence including a visit to the service. Standards 32, 34 and 35 were inspected. Evidence: The staff on duty during the inspection were friendly and helpful. We saw they got on well with the people who live in the home. They were observed working closely with them, helping them to make choices, and accompanying them out into the community. The relationship between the people who live in the home and the staff was informal and warm, with lots of shared jokes and banter. The home is well staffed which means that the people who live there get lots of opportunities to get out and about. All the service users we spoke to said they liked the staff. One told us, All the staff look after us. Photos of the members of staff on duty during each shift are on display in the dining room. This helps service users and their visitors identify whos who. Recruitment procedures were discussed with the Owner. He told us that all staff are subject to CRB and POVA checks, and references are obtained. Staff files were sampled and had the appropriate documentation in place. This helps to ensure the Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: people who live in the home are safeguarded. Staff receive good training opportunities and there is programme of appraisal and supervision in place. This will help to ensure staff have the support and skills they need to carry out their work. Staff comments about the training included: We get a lot of training - new courses and refresher courses. Im learning more now that I ever have If I need training I ask for it and they provide it. Care Homes for Adults (18-65 years) Page 25 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 . Quality in this outcome area is good. The home is safe and well managed and the people who live there are involved in the way it is run. This judgement has been made using available evidence including a visit to this service. Standards 37, 38, 39, and 42 were inspected. Evidence: The homes Registered Manager was not working on the day of inspection so we met with the Owner. He is based at the home four days a week and involved in both the care and administrative side. He was enthusiastic about the potential of the service users and gave examples of how individuals had improved since being there and were now getting out into the wider community and using public transport. All the service users we spoke to praised the homes Owner and Manager. One told us, I have a chat with the Owner every day, and another said, The Manager looks after us. Staff told us that both the Owner and the Manager are supportive and help them to increase their skills through training and experience. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: Records showed that staff use a number of strategies to involve the people who live in th home in its running. The Owner said group meetings dont tend to work due to the varying abilities of the service users, but staff are able to communicate with them all using either speech, pictures, or sign language. They also observe them to build up a picture of their preferred lifestyles. In addition annual quality assurance questionnaires are sent out to service users family, friends, and representatives to give them the opportunity to comment on the home. Arrangements are in place to promote and protect the health and safety of all who live and work in the home. A record of health and safety checks is maintained, and risk assessments are carried out to ensure compliance with health and safety regulations. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description 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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