the instruction and supervision of specialist care and support staff. individuals requiring care remain in their beds, neglecting to change dirty clothing, quickly handing over food to persons requiring assistance while eating, as well as giving meals to individual residents in a disorganised manner or not providing them at all. According to information provided by the visited facilities, the proportion of residents with dementia in a particular facility was often significantly more than half. Despite this fact, many facilities did not have any specialist care staff with a supplementary qualification for gerontological psychiatry. There is therefore a danger that the care and support provided to residents with dementia might not cater sufficiently to their particular needs. The right of residents to psychological and physical integrity must be guaranteed. It must therefore be ensured that necessary services are provided reliably, at the correct time and to the required standard. Care records In individual cases, it was doubtful whether all members of staff were sufficiently suited to their role of working with persons in need of care. An inspection of the complaints records, for instance, revealed evidence of inappropriate treatment by staff towards residents, poor staff morale, theft of money and jewellery, and nighttime disturbances caused by staff living at the facility. The National Agency found gaps and errors during an inspection of the care records. The biography page, for example, was sometimes missing, or prescribed medication was documented incorrectly. Furthermore, it was repeatedly found that care-related information was recorded both electronically and in paper form. However, some of the information was only recorded in one of the two systems. This can mean that not all of the information available at the facility is taken into consideration when needed. If care-related data are stored across different systems, it must be ensured that both of the systems are accessed (e.g. via cross-referencing). In order to ensure that the care and support provided by a facility is tailored to the individual needs of its residents, strong relationships between residents and caregivers are essential. This means maintaining a certain level of staff consistency and a sufficient calibre of personnel, both in terms of their qualifications and their professional ethics. It should be ensured furthermore that communication between caregivers and residents is not hindered by language problems. Frequent changes in personnel and the repeated employment of temporary staff are highly detrimental both to the individuals requiring care and the members of staff themselves. Additional training and management by specialist care staff is required in such cases, which then reduces the time available for carrying out specialist tasks. Furthermore, in order to ensure that care and support is provided appropriately and correctly, staff working conditions must be such that permanently excessive workloads and high levels of sick leave are avoided. In one facility, documents concerning admission, enduring powers of attorney and adult guardianship were only available in the administrative department. As a result, specialist care staff did not have unhindered access to these documents from the living areas. In order to prevent erroneous decisions when providing care and support, documents of this nature must be available at all times to the persons responsible for the care process. During an inspection of one facility’s documentation, it was found that “resident suffers from dementia” was documented in one case, and “forgets this very often because of her dementia” was documented in another. “Dementia” was not listed under the medical diagnoses in either of these cases. In the view of the National Agency, it is not acceptable to document “dementia” in cases where a resident shows signs of forgetfulness, for example. This approach gives rise to concerns that the selfdetermination of those affected could be restricted for no reason. 2.2.18 – Care and support In a few facilities, basic services were provided inadequately – in some cases with major delays – or were not provided at all. This included providing residents with body care, ensuring that 46