emergency bell has been triggered, staff should respond as quickly as possible in order to avoid causing unnecessary stress or potential injury to the person concerned. Facilities must adhere to statutory provisions in this area. 2.2.15 – Emergency exits In isolated cases, the National Agency found that it was difficult to identify the emergency exits as doors due to a variety of measures such as printed wallpaper or curtains. Furthermore, the door handles in one facility had been installed in an unusual way. 2.2.17 – Staff On the subject of staff, the National Agency’s recommendations primarily concerned availability, communication skills, qualifications and professional expertise. Facilities must ensure that emergency exits are clearly recognisable as such so that they can be used without delay during an emergency. Due to the aforementioned optical illusion and the unusual door handles, this was not guaranteed in the facilities in question. Residents might therefore be in danger in case of an emergency. There were complaints in several facilities regarding insufficient availability of staff, as well as persistently high staff turnover and sick leave. In some cases, this led to shortcomings in the level of care provided to residents, including a failure to provide body care, deficiencies with regard to hygiene, long waiting times after triggering the emergency bell, and key services being provided unreliably or not at all. In one case, a resident called the fire brigade on a weekend to inform them that she had been lying in her own faeces for several hours without receiving care. On another occasion, the residents’ committee of the same facility contacted the National Agency with a call for help, stating that the facility was severely understaffed and the residents were worried they might not receive adequate care. A subsequent review of the facility, which was carried out by the competent Ministry once it had been made aware of the issue, confirmed the residents’ fears. 2.2.16 – Emergency calls The recommendations concerning emergency calls referred primarily to residents’ ability to access the emergency call bell, the bell’s functionality, and staff reaction times after the emergency call has been made. It was noted in one facility that the emergency call bells above residents’ beds were sometimes too high for residents to reach while lying down. In spite of this, the required extension was either not made available to all affected residents or its position did not enable the emergency call bell to be triggered. One facility justified this by stating that, in the opinion of care staff, the residents in question were unable to use the bell correctly. The rooms were subject to regular visual checks. The intervals for these checks were stated as being between 30 minutes and two hours. As these inspections were not documented, there was no way of verifying that they actually took place. Residents in several facilities reported that they frequently had long waiting times before staff would respond to an emergency call. Waiting times of up to half an hour were reported in some cases. Several facilities employed temporary staff in order to offset staff shortages. According to the facilities, this included people with insufficient German language skills. This could jeopardise the provision of appropriate and correct care and support. It must be ensured that communication is possible between staff and residents – as well as between members of staff themselves. On specific night shifts, specialist caregivers were frequently outnumbered by non-specialists. In one facility, it was reported that nonspecialist staff providing care and support did not receive sufficient instruction or that they received no instruction at all. In addition, it was stated that no reviews were conducted of their work performance. Such practices give rise to concerns that residents could be harmed. Temporary staff should only be employed under Residents must be able to attract the attention of staff and request assistance when required. This means that emergency call bells must always be functional and accessible to residents (via an extension if necessary). Regular visual checks are no substitute for the ability to make an emergency call when needed. Once the 45