severely limited abilities to engage independently in meaningful activities. It is therefore important that facilities offer activities that are tailored to the interests and abilities of 42 these persons. Facilities must also take into account that some residents may have a strong need for movement and exercise. in the corridors, thereby blocking the escape route. Residential care and nursing homes should be fitted with smoke detectors. It is also advisable for facilities to have guidelines in place for responding in the event of a fire, as well as to train all staff members accordingly. Escape routes must be kept clear. In some facilities, bedridden residents were socially isolated and only received individual care a few times a week for a period of up to half an hour. Furthermore, it was also noted that the room of one bedridden resident entirely lacked surrounding stimuli such as images or scents etc. The National Agency is of the opinion that the conditions encountered were insufficient. Social isolation and the lack of stimulus can cause or intensify psychopathological changes, which can result in a significant deterioration of health and quality of life for those affected. It was therefore feared that residents’ rights to physical and psychological integrity had not been sufficiently respected. Appropriate measures must be taken to ensure there are sufficient stimuli in the residents' rooms. 2.2.7 – Privacy of correspondence In one facility, it was observed that individually named letter boxes were positioned in the corridors for delivering post to all residents living in that section of the facility. As these letter boxes were open, it was possible for unauthorised persons to access their content. It is therefore to be feared that the privacy of the persons concerned is not being adequately protected. Facilities must take precautions to protect residents’ inviolable right to privacy of correspondence. 2.2.8 – Nutrition In many residential care and nursing homes, the residents stated that they were not satisfied with the meals served. These statements were echoed in the facilities’ written complaints registers. Complaints concerned in particular a lack of variety of the meals served, too small portions, and poor quality. In one case, persons requiring assistance at meal times were not fed individually. The facility explained that this was due to a lack of staff. In a further facility, it was found that not all residents were aware of the option of having a late evening meal. As a result of this, the residents concerned complained that the time span between dinner and breakfast was too long. At one of the facilities visited, the nearest bus stop was approximately one kilometre away. This made it difficult for visitors travelling by public transport to access the facility. Yet it also made it more difficult to bring residents, for example, on a trip to the city centre and thereby ensure social participation. Facilities should be adequately connected to public transport. 2.2.6 – Fire protection In isolated cases, some residential care and nursing homes were found not to have smoke detectors, while in others the installed smoke detectors were not working. In several cases, facilities had not developed their own individualised fire safety concept to provide employees with concrete instructions in the event of a fire, for example on how to conduct an evacuation. It was also repeatedly found that nursing trolleys or wheelchairs had been placed An imbalanced diet and too small portions can lead to nutrient deficiencies and result in health consequences. Furthermore, too long a wait between meal times can cause acute health complications in particular in people with diabetes mellitus or dementia. The meals served in residential care and nursing homes should meet the requirements of 43 nutritional guidelines for the elderly. All 42 Federal Ministry for Family Affairs, Senior Citizens, Women and Youth; Federal Ministry for Health (ed.): “Charta der Rechte hilfe- und pflegebedürftiger Menschen”, [Charter of rights for persons requiring assistance and care], Article 6, version of: March 2015 43 Deutsches Netzwerk für Qualitätsentwicklung in der Pflege [German Network for Quality Development in Care 40