- to fence the yard of the home so as not to allow the users to leave the home without control; - to justify the decision for the rearrangement of the buildings of the home into a CAFT, which is outside a populated area and is remotely located from any other services in the community; - to justify the decision to establish a CAFT for people with mental disorders in the yard of the HELMR. The opinion of Sevlievo Municipality is that there are no sufficient funds to implement the recommendations and that "the location is suitable and the people from the village are used to the users that consider the institution as their own home“. The opinion of the MLSP coincides with the information provided by the Municipality. Administrative capacity and support The NPM finds appropriate to emphasise the importance of the location of the homes for the recruitment of specialised personnel. A valid conclusion can be drawn with respect of all homes inspected during the year that the specialised staff is insufficient having in mind the number of the users, thus questioning the quality of the social service provided. There are many locations where no funds have been set aside for training of the employees of the specialised institutions in view of the specifics of the work with people with dementia, mental retardation and mental disorders. This results in cases like the menus presented to the NPM at DEPMR – Malko Sharkovo, Bolyarovo Municipality, of which a conclusion can be drawn that the food offered is not balanced and does not meet the requirements of art. 41, para 1 of the Rules on the Implementation of the Social Assistance Law. Medical care Despite the set profile of the home for people with mental retardation in the HEPMR for men and women in Pchelishte Village, Veliko Tarnovo Municipality, there are 3 people accommodated with a primary disease – mental disorder, 6 with epilepsy and 5 diagnosed with Child Cerebral Paralysis (CCP). During the time of the inspection the NPM team found that the rehabilitator visits the home 16 days during the month for 4 hours, during which time he provides care to all users, including the CCP suffering individuals. According to NPM this is extremely insufficient in view of the provision of high quality medical and rehabilitation care to people suffering severe disabilities. In this respect the NPM emphasises once again the importance of the optimum medical care for the individuals placed in institutions for specialised resident care for elderly people. Despite the constant recommendations of the NPM there has been no change in the practice where in case of death of a user the death certificate is drawn up by the general practitioner and no pathoanatomy expertise of the diseased is performed. It was found as a result of the inspections of the files of the users that in many cases no preceding disease has been recorded, which might subsequently be the possible cause for death. 30

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