Inspection on 14/12/06 for Lady Forester Residential & Day Care Centre

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lady Forester Residential & Day... 04/03/09

Lady Forester Residential & Day... 23/09/08

Lady Forester Residential & Day... 10/12/07

Lady Forester Residential & Day... 06/12/05

Lady Forester Residential & Day... 12/04/05

Lady Forester Residential & Day... 07/12/04

Lady Forester Residential & Day... 13/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lady Forester Residential & Day Care Centre Church Street Broseley Shropshire TF12 5BQ Lead Inspector Karen Powell Key Unannounced Inspection 14th December 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lady Forester Residential & Day Care Centre Address Church Street Broseley Shropshire TF12 5BQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01952 884539 01952 884552 Lady Forester Residential & Day Care Centre *** Post Vacant *** Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home must have two (2) staff awake on duty at night, due to the layout of the building. The home must have three (3) care staff on duty at all times during the day, due to the layout of the building. 6th December 2005 Date of last inspection Brief Description of the Service: Lady Forester Residential and Day Care Centre is registered with the Commission for Social Care Inspection to provide accommodation and personal care to a maximum of eleven elderly people. Nine rooms are provided for permanent service users and two beds are provided for respite purposes. The general manager is Beryl Wickstead. An application for registration with the Commission for Social Care Inspection has been submitted. The home is situated on the outskirts of Broseley, Shropshire and set in well maintained grounds. The building was formerly the Cottage Hospital. The centre is a charitable organisation and managed by a board of Trustees. The home is situated on the ground and first floor of the centre, which is accessible via a passenger lift. A small lounge and dining area is situated on the ground floor. All bedrooms are single. Day Care is provided Monday to Friday on the ground floor and the service users of the home are able to participate in activities arranged by day care staff if they wish to do so. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. One inspector carried out the inspection. The visit lasted seven and a half hours. It included talking with service users, relatives, the manager and members of staff on duty, case tracking service users, observing work practices, looking at a number of records and a tour of the home. All 22 key national minimum standards and in addition standards 1 & 7 for older people were assessed and a quality rating provided based on each outcome area for service users. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The service users, manager and staff on duty were welcoming and co-operated fully throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 6 The statement of purpose and service user guide must be reviewed and an up to date copy sent to the Commission for Social Care Inspection. Care plans must be developed for all service users detailing how care needs of individual’s are to be met taking into account service users preferences. Risk assessments related to any task that potentially causes a risk to the service user or staff member must be in place and reviewed with the care plan at least annually or when required. There are a number of requirements relating to national minimum standard 9 – medication, the main issue relating to secondary dispensing, which must cease with immediate effect. All staff must undertake abuse awareness training. A policy must be developed for the handling of service user finances. The outstanding requirement made by the fire officer at the 1st February 2006 inspection must be fully actioned. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Information about the home is provided to service users and their families, this is in need of reviewing. There is a clear assessment process in place. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service user guide, which is issued to all new service users living at the home. There is lots of useful information included in the documents but they have not been reviewed since 2003 and must include all of the information as detailed in the older peoples national minimum standards and schedule 1 of the care homes regulations 2001. One new service user spoken to said that they had been given the information when they recently moved into the home. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 9 All service users are assessed prior to moving into the home. Records of assessments were seen on service user files. The file of a self funding service user was examined as part of the case tracking process and was seen to contain a copy of the assessment completed. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. The care planning and review process is not clear. Health needs are met by close liaison with health care professionals. Practices relating to medication administration places service users at risk, all other aspects of handling and storage of medication is in line with policy and procedures laid down by the home and followed by trained staff. The principles of privacy and dignity are put into practice by the staff team. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of two service users were examined during the case tracking process. These included a new service user and a service user that has lived at the home for sometime. One service user file did not contain a care plan, the Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 11 second contained insufficient information for carers to know how the service users needs should be met taking into account individual preferences. Through discussion with the manager and staff it was clear that they had a knowledge of individual’s needs and daily routines. Service users confirmed that they felt their needs are met by a caring staff team. Service users looked well cared for and comfortable in their surroundings. They were seen to be accessing the day care facility during the visit. During discussion with service users, relatives and the manager it was established that service users health needs are monitored and close liaison with health care professionals is requested when required. Documentation at the home fails to demonstrate some of the positive aspects of care delivered to individuals and the home needs to develop this area of record keeping. There is a medication policy and procedure in place, however this requires minor amendment to ensure staff are clear about how medication must be administered following the guidelines of the Royal Pharmaceutical Society. On discussion with staff it became apparent that staff currently secondary dispense into named tots out of the monitored dosage system put up from the chemist. This unsafe practice was discussed with the staff member and manger at the time of the inspection and told that it must cease immediately due to the potential risk to service users. During the home tour eye drops were located in the general food refrigerator on the unit, medication requiring refrigeration must be stored in a separate drugs fridge and all medication such as eye drops must be dated when opened. Records relating to the administration of medication were generally satisfactory with the exception of one controlled drug, which did not have an accompanying MAR sheet. The stock could be seen in the controlled drugs register, however, this is not a record of administration. A distance learning medication course is currently being undertaken with Walford College. Eight staff are undertaking training for the first time and nine staff are refreshing their knowledge. The manager of the home has also undertaken medication training. Service users were happy to chat with the inspector about care delivery and all people spoken to were complimentary about the care they receive. Individuals said that staff were ‘kind and caring’, staff ‘look after me well in the way that I want to be looked after’. The topic of privacy and dignity was discussed and the inspector was pleased to hear from service users that staff are sensitive when delivering personal care. The principles of privacy and dignity was discussed with staff and through observations made on the day it was clear people were spoken to with respect, staff knocked bedroom doors before entry and mail was given to service users un opened. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 12 During the tour of the home communal toiletries were seen in the bathroom, these were unmarked along with other items such as a razor and flannel unnamed. These items should be clearly named and used only for the individual they belong to. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Service users are able to chose their lifestyle and keep in contact with their families and friends. Activities are varied and service users can attend the day centre within the home if they wish. There is a varied menu offering diets to meet individual preferences. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are welcome to attend the day centre within the residential centre, some of the service users told the inspector that they were aware of the home before they were admitted as they attended the centre when they lived as a resident in the local community. On the day of the inspection service users were seen attending the centre where a singer was entertaining the group with Christmas songs, earlier in the day a group of local children had sang Christmas songs. The day centre is staff separately to the home. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 14 The manager and staff told the inspector that they are trying to promote the use of the downstairs lounge and had recently encouraged those who wished to enjoy Sunday lunch in the dining room/lounge. Visitors were seen to come and go during the visit and service users told the inspector they could receive visitors at anytime, although they are asked to try and visit outside of mealtimes. Observations of individual’s being able to entertain in the privacy of their own rooms was noted during the inspection visit. A recent shopping trip has taken place to Telford town centre and a Christmas party was enjoyed by all earlier in the week. All service users who spoke to the inspector reported that they really enjoyed the party. Those individuals without relatives are made aware of how to access advocates and literature regarding these were on notice boards within the home. Service users have access to ministers of the church and the parish magazine is provided to all those service users who wish to have a copy. Individuals are encouraged to bring their own possessions in and to personalise rooms according to choice. All service users spoken to said the food was of a good standard and they offered a varied diet and alternatives if required. At the time of the inspection diabetic diets were the only specialised diet being catered for. One service user with a current dental problem is being catered for by a soft diet. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 There is a clear complaints procedure in place. Clear policies and procedures regarding adult protection are in place, not all staff have had the required training to support them in developing their knowledge in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear complaints procedure in place, although service users did not necessarily know the formal route of making a complaint they knew who to speak to if they had concerns about any aspect of the service they receive. There have been two complaints received at the home since the last inspection. Records of both complaints were detailed satisfactorily. There have been no complaints made to the Commission for Social Care Inspection. Policies and procedures are in place for dealing with any allegations of potential abuse. Staff spoken to were fully aware of the action they should follow if they suspect any allegations of abuse. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 16 Examination of staff training files showed that not all staff have undertaken abuse awareness training. The manager does have a course booked in abuse awareness in the near future. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Lady Forester care home is comfortable and homely and service users live in a well-maintained environment. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home offers comfortable accommodation and all service users spoken to were satisfied with their personal space and general environment. Discussion with the manager and responsible individual about the homes annual development plan included that decoration is on a rolling programme. Some of the roof tiles are being replaced this week, which led to a leak in the bathroom, once these have been replaced the bathroom is scheduled to be redecorated at the beginning of February. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 18 As mentioned previously service users are encouraged to personalise their rooms and those seen were comfortable and clean. A home tour took place and all areas of the home were clean and tidy. The laundry is well equipped. COSHH safety data sheets are not available at the home and the manager must ensure that these are obtained to accompany each product in use and made available to staff who use them. The manager is currently exploring infection control training with Walford College for all staff including herself. This is being planned for the end of February 2007. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of service users. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the appointment of the new manager in May 2006 training opportunities for staff are being addressed. A local GP and trustee member has provided some Parkinson’s awareness training on 3rd and 10th May 2006. The training plan includes dementia training to take place in March 2007, medication training already in progress and infection control as previously mentioned. Fire training has been organised by an independent training consultant. Moving and handling refresher training has been arranged for 11 January 2007. The manager reported that thirteen staff are qualified to NVQ level 2, four staff are undertaking level 2 training and two are due to commence NVQ level 3 training. Examination of the rota’s for the month of December showed appropriate staffing levels and skill mix for the home. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 20 The personnel files of four new recruits appointed to the home since the last inspection were examined to monitor recruitment practices. In all instances robust procedures had been followed and all files contained the relevant information required by the Care Homes Regulations 2001. There is no use of temporary or agency staff. All new staff undertake induction training linked to the Skills for Care induction standards. Records of completed induction training was seen for all new staff appointed. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness. Systems need to be developed to ensure that quality assurance of the service is reviewed to maintain good outcomes for service users. EVIDENCE: The manager has been in post since May 2006. In that time she has undertaken training to develop her own knowledge and skills for the role she has been appointed to carry out. Training includes supervision of health and safety, negotiating employment, first aid, risk assessment and medication training. She is waiting funding to undertake her registered managers award. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 22 An application for registration with the Commission for Social Care Inspection is in progress. Through discussion with service users and staff it was established that service users best interests are always considered. Service users were happy to tell the inspector that they can freely talk to the staff and that they feel their views are listened and acted upon. The home has a quality assurance policy, which includes an annual questionnaire, this is expected to be done in the New Year. Given that the manager has addressed more priority issues it is acknowledged that this has not yet been carried out in the home, although it has been undertaken in the day centre. A brief examination of the policy suggested that this could be expanded to include the internal quality visits undertaken by the trustees and service user reviews. All service users are encouraged to deal with their own finances, locked facilities are available in each bedroom to do this. One of the service users case tracked has money held in safe keeping this was checked against records and money held. The balance and records were found to be satisfactory. There is no ‘dealing with service user finances’ policy in place and the home must develop one. The manager has undertaken appraisals with all staff. Supervisions have begun and are planned for all staff that have not yet had a session. The manager acknowledged that supervisions need to continue to support staff and will continue on a rolling programme. The health and safety of the building is the responsibility of the manager. During discussions with her it was established that one requirement from the fire officers visits on 1st February 2006 is still outstanding. It was agreed that the manager would address this outstanding issue. An independent consultant has provided training in fire safety, a record of training undertaken must be maintained as required by the fire officer. Records relating to annual servicing of equipment were seen to be satisfactory. PAT testing is being arranged for the New Year. During the case tracking process it was noted that in particular one risk assessment relating to bathing required more detail. The manager agreed to review this. A portable heater in use in the downstairs lounge requires a risk assessment to be completed. Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 3 x 2 Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP7 Regulation 4, 5 schedule 1 15(1)(2) Requirement The statement of purpose and service user guide must be reviewed. All service users must have a plan of care, which sets out in detail how individual care needs are to be met. (Previous timescale 31/01/06 not met) Secondary dispensing of medication must cease immediately. Eye drops must be dated when opened. Drugs requiring refrigeration must be stored in a separate drugs refrigerator. The medication policy must be reviewed to include the procedure for administration of medication. All items of medication must have an accompanying MAR sheet. Communal toiletries must not be in use and service users dignity maintained at all times. All staff must undertake adult protection training. A handling service user finances DS0000020681.V296684.R01.S.doc Timescale for action 14/01/07 14/03/07 3. 4. 5. 6. OP9 OP9 OP9 OP9 13(2) 13(2) 13(2) 13(2) 15/12/06 15/12/06 14/01/07 14/02/07 7. 8. 9. 10. OP9 OP10 OP18 OP35 13(2) 12(4)(a) 13(6) 18(1)(a) 13(6) 15/12/06 14/01/07 14/03/07 14/02/07 Page 25 Lady Forester Residential & Day Care Centre Version 5.2 11. 12. OP38 OP38 23(4)(a) 13(4)(a) policy must be developed. All requirements made by the 14/02/07 fire officer must be implemented. A risk assessment must be in 15/12/06 place for the use of the portable heater. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lady Forester Residential & Day Care Centre DS0000020681.V296684.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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