National Preventive Mechanism plates through a kitchen hatch. There were no occupational opportunities to stay active and no possibility for co-determination and participation. The NPM considers such remunerated forms of residence for persons with mental or neurological diseases to be inappropriate. Independence, self-determination and individual responsibility were neither guaranteed nor promoted in the facilities that were criticised. The core principles of the UN CRPD were violated. Restrictions of freedom were imposed as a result of a lack of structural suitability, the provision of sedatives or measures that made it impossible to leave the buildings. The living conditions encountered in these officially not approved facilities breached the dignity and autonomy inherent within each individual, along with the freedom to make their own decisions. Above all, there is no promotion or full and effective participation and inclusion into society if older people do not have any opportunity to integrate into community life due to the isolated position of the facility. Disregarding the UN CRPD The NPM sees it as its responsibility to point out, that vulnerable persons must be protected against the risk of neglect and inadequate medical care by private individuals. Nobody may be denied the right to live out the final years of their life with dignity. Even the consent of legal guardians or relatives to precarious forms of support does not change the fact that, according to the Federal Act on Healthcare and Nursing Professions (Gesundheits- und Krankenpflegegesetz), nursing activities against payment may only be performed by adequately trained staff. Also the Human Rights Advisory Council indicates in its statement that public institutions and facilities charged with the protection of the physical and mental integrity of individuals are under a duty to guarantee reasonable (statutory and administrative) protection against potential abuse by private persons, if they are or should be aware of the care arrangements. The state‘s duty to protect As operators of facilities for persons with disabilities and those who are responsible for social welfare, the Laender must provide effective protection and care to persons with impairments against dangerous, inhuman or degrading treatment. This also entails that care arrangements that have not been officially approved must be controlled and that amateur nursing must be prohibited. XX In order to comply with their duty to protect persons with severe impairments under human rights law, supervisory authorities must investigate all evidence. They must prohibit treatment of persons with severe impairments in facilities that have not been officially approved. 113