Care Home: Russett House

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What the care home does well This inspection visit was very positive. The registered manager was not on duty but the home was running smoothly and was well organised. The home had a relaxed and calm atmosphere. Staff were seen and heard to interact in friendly and helpful ways with the people they support. Staff demonstrated a good understanding of the people they care for. All people received a good level of care and support. A high level of sensitive input was given to a small number of people with higher level needs throughout the day. The staff team are experienced and demonstrated expertise in their caring and support roles at the home. The home has been redecorated and refurbished it is well presented, comfortable and homely. The home is well equipped to meet the needs of the people living here and there is some overhead tracking in individual rooms and in two communal bathrooms. What has improved since the last inspection? At the last inspection Russett House was being used as an intermediate home base for people whose care home was being refurbished. This work has been completed and the home has since been upgraded. There is a settled group of people in residence. Two requirements made at the last inspection have been addressed. What the care home could do better: The inspector did not see regulation 26 visit records, the file labeled as such contained only blank template reports. The same was found with the annual premises check file, yet other records and risk assessments were available. Records for preferences for personal care were not recorded in the care plans that were sampled; the inspector was informed that no preferences have been made. It was evident from the duty rota that night staffing may be male staff only, this gives no opportunity for a choice to be made possible. This was raised at the last inspection and a review is recommended at this inspection. . One medication record did not have guidelines for a recently dispensed rescue medication. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Russett House 52B Southway Drive Yeovil Somerset BA21 3ED     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: Barbara Ludlow     Date: 1 0 0 3 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 29 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Russett House 52B Southway Drive Yeovil Somerset BA21 3ED 01935425911 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): njrickwood@somerset.gov.uk Somerset County Council (LD Services) Name of registered manager (if applicable) Janet Ferguson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: To provide a service for people with PMLD (profound multiple learning disabilities). To provide a service to people who, in addition to their learning disability, have an associated physical disability. Date of last inspection Brief description of the care home Russett House provides residential care and support to up to ten service users with profound, multiple, learning disabilities. It is a Local Authority home. Ms Janet Ferguson is the registered manager of Russett House. There are currently ten people living at the home. Major building work took place at Russett House to upgrade the building and combine two previously registered homes on the same site (Hardy House and Elliot House) as one. Accommodation consists of ten single bedrooms, four with overhead tracking, and five with en suite facilities (not all rooms have en suite facilities) two lounges, two assisted Care Homes for Adults (18-65 years) Page 4 of 29 care home 10 Over 65 0 10 Brief description of the care home baths, two wet rooms, two laundry rooms and one ironing room, a staff/visitors room and a kitchen. There is a staff office. Outside there is a garden to the back of the house and a patio. There is a car park with a gate leading to the facilities of the main street. Two staff provide waking night cover and may be called on to provide support in other homes in the network in the event of an emergency. The fee range is individually costed. Care Homes for Adults (18-65 years) Page 5 of 29 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: The registered manager of the home submitted the Annual Quality Assurance Assessment to the Commission, this document gives information about the home over the past twelve months and plans for the next twelve months. This document includes numerical data about the service. Surveys were sent out prior to the inspection visit for people living at the service, the staff and to visiting professionals. Feedback and comment is incorporated into the inspection report. The unannounced inspection visit was made by one inspector. The visit commenced at 11.25am and closed at 5.25pm. Care Homes for Adults (18-65 years) Page 6 of 29 The visit was well received and the inspector spent time observing daily life at the service. Five staff were on duty at the start of the visit and all were spoken with. There were ten people in residence, people were seen during the day and time was spent with a number in the communal rooms at the home.The redecoration of the dining room was in progress so the extent of the communal space was not in full use. Records were sampled these included care plans and maintenance records. Staff recruitment, training and supervision were discussed with staff during the visit. Lunch time was observed and the preparations for tea. Feedback was given at the person in charge at the close of the visit. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Adults (18-65 years) Page 8 of 29 7535. Care Homes for Adults (18-65 years) Page 9 of 29 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 29 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. There are good systems in place to ensure that thorough pre admission assessment is undertaken. Evidence: Introductory visits are arranged to allow people to view the home, meet people and try the home before committing to a place here. The manager had indicated in the Annual Quality Assurance Assessssment that transition plans for people have been in place with visits and overnight stays and these have helped people to make an informed choice of Russett House. And over the past twelve months the home have accessed an independent advocate for people when necessary and have also had physcology expertise to assess the environment and individual needs. There has been only new person admitted to the home since the last inspection. They had a detailed care plan in place that has been regularly reviewed. The pre admission Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: assessment was thoroughly undertaken to prevent an inappropriate placement being made and risking the placement breaking down. Care Homes for Adults (18-65 years) Page 12 of 29 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 people living at Russett House have detailed care and support plans that reflect their assessed needs. People are involved in the decision making about daily life to the extent of their abilities. Risk assessments are completed where required to support independence in lifestyle. Evidence: Care and support plans are developed from admission to the service with the use of the community single assessment (SAP) and with input from professional health and social care workers and all relevant others. One professional responding to the Commission (CQC) said that their professional input can be ignored if it does not fit in with the managements ideas. People living at Russett House have very profound disabilities and receive support to achieve as much as they can and participate as much as they can. Communication is Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: recorded in the care plan indicating the persons preferred method of communication, this may be very subtle requiring skill and expertise from staff. This was seen at the inspection when staff were observed to be responding sometimes to subtle cues and sometimes intuitively to communications for assistance from the people they support and care for. Regular care plan reviews and the input of the key team carers plus the community care annual review, keep pace with changes in people needs. Skill development plans are used to encourage progress with achievable goals in daily living. Relatives and advocates for the people living at the home are encouraged to be involved and are welcome to visit at any time. There are regular in house checks made on finances and the local authority undertakes thorough, regular monitoring audit of financial transactions and all records and balances on behalf of the people in residence. People have individual safe storage which is a locked drawer in their bedrooms. The AQAA indicated that there are person focused key teams. At the visit we heard about key teams, one team of six staff take responsibility for four people. The staff team have an overview of people in their care for health, social care, skill development and the care plan, medications. Communication with people includes helping them to remember events such as the birthdays of family and friends. The key teams meets every two to three months to update the care plan to ensure that an individuals needs are met. Staff responding to the Commission by survey said the service offers a good amount of choices, good daily activities and trips out. People have a healthy diet / choice of food. Care Homes for Adults (18-65 years) Page 14 of 29 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. People living at Russett House have opportunities to take part in activities and social events both at the home and in the wider community. Community facilities are accessed such as local banks, cafes, and shops. Contact with family and friends is encouraged and visits are supported. The catering at the home is undertaken to suit individual dietary needs and tastes. A mixed and nutritious menu is served. Evidence: Activities are planned for people living at the home. Staff support regular activities across the daytime and evening. Swimming was being planned for two people who regularly go out with staff one evening each week. People spoken with were pleased to communicate how they spend their time. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Each person has a My Days chart with the recreational options chosen by them and available to them, if they wish to participate. A record is kept of how people spend their time each day and of any care they have received and of any important events. People living at Russett have access to the community health care team and their social worker. Some people have family with whom they may spend weekends and holidays. Family contacts are encouraged and supported. Regular contact is made with families to ensure they are kept in touch with their relatives and with the home. Some people require special diets. Staff were skilled in the preparation of food to meet the persons assessed needs such as a soft consistency and food to meet individual choices and tastes. There was flexibility to ensure people were having what they wanted to eat at mealtimes. The home has a dining room and dining area in the kitchen. The dining room was under going redecoration at the time of this visit, one person did have lunch in their regular seat to prevent disruption to their routine. Staff were seen to give discreet supervision and assistance to people at mealtimes, encouraging and ensuring they managed to eat safely and a sufficient quantity. Drinks were seen to be served regularly throughout the day, on request and at meal times. Meals away from the home are taken at pubs, cafes or restaurants. Last month there was a fish n chip trip out on Fridays. We heard that such outings are dependent upon sufficient staff numbers being available to support people on the outing. Surveys from members of staff indicated that there are usually enough staff, one person felt the activities could be improved if there were more staff available. One professional said the activities in house could be improved if more time and consideration could be given to activities within the house, it was said that this would avoid people sitting around doing very little and with little interaction. Care Homes for Adults (18-65 years) Page 16 of 29 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. People living at Russett House receive good attention to their personal and health care needs. Medication was safely stored and generally safely managed. Evidence: All people living at the home looked to be well groomed and well dressed. Throughout the day people received attention to their individual physical and emotional needs. One person received subtle attention from the staff team which kept them safe as they moved around independently. At the last key inspection attention was brought to the night staff team being predominantly male and it was felt that there should be a choice of staff gender for personal care giving. The duty rota seen had nights with a male staff team on duty. It was confirmed that there was no one in residence who would object to having personal care from a male carer. This is not ideal and the rota should offer a choice of carer at night. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: People had their own aids to enable them to optimise their posture and mobility around the home. There was attention to comfort with appropriate seating and regular opportunities to rest and relax in a changed position or period in bed. Beds are adjustable and had integral rails where required for safety. Risk assessments were in place for the use of such equipment. The use of activities to exercise such as swimming and outdoor activities are taken. Two people were looking forward to go swimming in the evening of the inspection day. There was evidence of staff training to meet the care needs of the people living at the home. Community health care staff have taught skills such as the care and maintenance of gastric tube (peg ) feeding to the home staff, to ensure individual care needs can be met. Staff confirmed that they have received training with emergency aid medication for individuals who have epilepsy. The medication management was good. Each person has a lockable drawer in their bedroom for the safe storage of their medication. Staff have access to policies and procedures for the safe management of medication. Guidelines for rescue medication were not all in place. One person who had two different medications only had one set of guidelines, the prescribed medication had been recently dispensed yet the seizure care plan indicated that the the home continue to be awaiting guidelines. This should be rectified. Care Homes for Adults (18-65 years) Page 18 of 29 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. People are safeguarded from harm by robust application of policies and procedures at the home. Financial matters are safeguarded by regular checks, audit and procedures. Recruitment processes are thorough and include CRB checking prior to staff commencing work at the home. Complaints are taken seriously and are responded to appropriately. Evidence: There is a local authority complaints procedure, this is available in Somerset Total Communication format. One complaint was reported on the AQAA, this was resolved within 28 days and was not upheld. The home has a whistle blowing policy and staff have access to the raising concerns leaflet. The finances at the home are subject to scrutiny by a county council finance officer. This process is undertaken at regular intervals with examination of all financial matters at the service. There are also in house checks on peoples finances to ensure safekeeping is maintained at all times. The Somerset Safeguarding Protocol would be followed in the event of a allegation of Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: abuse being raised. The AQAA confirmed that there is careful recruitment with Criminal Record Bureau (CRB) checks undertaken prior to new staff employment, to ensure that they are suitable to work with vulnerable people. Staff asked confirmed this level of recruitment process. Care Homes for Adults (18-65 years) Page 20 of 29 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. The home was fresh, clean and homely. The home is well maintained and suitably adapted for comfort and accessibility. Bedrooms are personalised to suit the individuals taste. Evidence: A tour of the premises was made and with individuals permission bedrooms were sampled. The home was all clean and tidy. Redecoration of the dining room was in progress, the impact of the work was minimised for example where people had particular needs that required the use of the main dining table for meals, access was made available to maintain their daily routine. This very pleasant home has communal rooms and outside there is garden on two sides of the house. There is a garden swing that has a special soft safety surface beneath it in case of falls, and there is a garden summerhouse. Bedrooms sampled during the tour of the premises were nicely decorated and personalised. The bedrooms were also well equipped, to meet the needs of the people in residence. The home has a mix of bathing or shower facilities. Two communal bathrooms have Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: overhead bath hoist tracking and four bedrooms are fitted with overhead hoist tracking. One was seen, the overhead tracking went from the bed into the en suite shower area. The risk of cross infection is well managed. There are hand washing facilities for staff around the home with liquid soap, paper towels and appropriate disposal for waste. Staff have received training in infection control. Care Homes for Adults (18-65 years) Page 22 of 29 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 home has an experienced and dedicated staff team. Staff are carefully recuited and receive ongoing training and supervision. Evidence: At this inspection there were four regular care staff on duty and one member of staff from the relief team. This person knew the people living at the home well and was expereinced in care. This seemed to be a sufficient number of staff on duty, all staff were kept busy throughout the day. Staff are recruited in line with policies and procedures that will protect people from harm. Staff asked confirmed that checks such as their Criminal Record Bureau (CRB) check had been undertaken prior to them commencing work at the home. The duty rotas were examined and these showed three occasions where the two night staff on duty were male. It was confirmed that there are no people in residence who have expressed a preference for female carers only. This limit on choice was brought to the attention of the management at the last inspection and is reiterated at this inspection. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: At night two waking staff are on duty, there is an arrangement that one staff can be called upon to attend other homes in the supported living network in an emergency. Staff reported that there is no change in this arrangement which commences at 10pm each night. Care staff have access to National Vocational Qualification (NVQ) training and personal skills development as required by their role. There is an induction training course that is run centrally by the local authority for all new staff to attend. Care Homes for Adults (18-65 years) Page 24 of 29 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. This service is well managed. The interests of the people in residence are taken into account in all aspects of the homes development and day to day management. The home is well adapted and equipped and is safely maintained. Evidence: Care records, staff training and observed practice indicate that communication is paramount. Staff have expertise with the people they care for and respond with sensitivity and intuition with the people they care for. The people living at Russett House have family and professional involvement in their care arrangements to support and to promote their best interests and good outcomes in their daily living experiences. The home is well maintained and redecoration that was not disruptive of daily life at the home, was in progress on the day of the inspection visit. Accessible records were sampled. Records for regular checks and maintenance of the premises are kept. The Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: home has maintenance contracts for overhead hoist tracking and portable equipment. The homes minibus is likewise maintained. The home has operational management from a network manager and auditing is carried out to further monitor the care and service provision at Russett House. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 27 of 29 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 1 18 The service should consider having a both female and male staff on duty at night to provide a choice for people receiving personal care. Guidelines for staff for safe administration of a rescue medication should be in place when prescribed for an individual. 2 20 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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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