Care Home: Wishing Well

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What the care home does well What has improved since the last inspection? Ongoing decoration of the home has taken place since the last inspection. People have been involved with this process. What the care home could do better: Improvement is needed with the organisation and updates of the care plans and risk assessments. This will provide staff with a more informed picture of what the care needs of people are. The recruitment process must ensure two references are obtained before a person can start work. CARE HOMES FOR OLDER PEOPLE Wishing Well 37 Leven Road Dringhouses York YO24 2TL Lead Inspector Sean Cassidy Unannounced Inspection 8th October 2008 09:30 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 Wishing Well DS0000015835.V372970.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. Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wishing Well Address 37 Leven Road Dringhouses York YO24 2TL 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) 01904 337566 01904 337566 DEDEPIP@aol.com Mrs Denise Mary Thompson Care Home 4 Category(ies) of Old age, not falling within any other category registration, with number (4) of places Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 4 25th October 2007 2. Date of last inspection Brief Description of the Service: Wishing Well is a care home registered to provide personal care and accommodation for up to four older people of either gender. The home consists of a two-storey semi-detached house situated on a quiet road in a suburb of York and is within walking distance of local facilities and amenities including shops, cafes and pubs. The amenities of York city centre are also accessible by transport. The home has recently had approval for occupancy to be increased from three to four service users. All four bedrooms are for single use and are on the first floor, close to the shared bathroom. The newly registered room is en-suite. There are additional WC facilities on the ground floor. The home has a well-maintained garden and an area of hard standing for parking at the front. The registered person is the main carer and her husband and three part-time care assistants assist. The registered person and her husband live on the premises in a second floor loft conversion. Details provided during the inspection visit on 25 October 2007 outline the weekly fees as between £349 for standard single rooms and £425 for the one single en-suite. This does not include hair perms, however chiropody services, a weekly shampoo and set, if required, and individual toiletries are included. Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit carried out by one inspector that started at 9:30 and finished at 15:00 on 8 October 2007. The accumulated evidence in this report has included: • • • A review of the information held on the home’s file since the last inspection. Information obtained from residents, relatives, staff and other health care professionals. Information received from the Annual Quality Assurance Assessment document provided by the manager. One inspector conducted an unannounced visit to the home, which lasted one day. The majority of this time was spent looking at documentation, speaking to residents, management, staff and relatives. A number of documents were looked at during the visit and parts of the environment used by the people living there were also looked at. A proportion of time was spent speaking to the manager, the deputy manager, staff and visitors. The information required from the service in the form of the Annual Quality Assurance Assessment was obtained before this report was written. The manager was provided with feedback at the end of the inspection. The weekly fees charged at the time of inspection were £360 - £480 per week. What the service does well: People are provided with good information about the service. Evidence was seen to show they are enabled to visit the home to look around and chat to staff prior to taking up a place. This helps prospective residents to make an informed choice about whether they want to take a place at the home. Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 6 The home is well managed and the staff are competent in their roles. They are happy in their work and committed to providing high standards of person centred care. The needs of people are the focus of the staffs’ attention and people looked happy and well cared for. Staff make sure that people are treated with dignity and respect. Staff are also good at supporting family members who visit the home. The manager makes sure that the residents have whatever they need to make their lives fulfilled, interesting and ‘normal’. They have the opportunity to contribute to the day to day running of the home whether this is helping in the kitchen, or choosing foods at the supermarket. The plans of care are very individualised and provide good detail about what help is required to enable the residents to be as independent as possible. The home works closely with other healthcare professionals, makes referrals at an early stage and takes the advice that is given. Because the home is small, it is a very homely and family like situation and people are given a lot of one to one attention and support. People have the opportunity to contribute to the day to day running of the home whether this is being involved in helping choose the décor, helping in the kitchen, or choosing foods at the supermarket. What has improved since the last inspection? What they could do better: 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. Wishing Well DS0000015835.V372970.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 Wishing Well DS0000015835.V372970.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): 3 (standard 6 does not apply) People who use the service experience good quality outcomes in this area. People said they were provided with enough information they needed to make the choice about moving into the home. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: People spoken to said they were given a tour of the premises when they arrived to look around the home. The manager was very helpful and explained the full ethos of the home to them. They said they were fully informed about moving in and that they could not have asked for a better process. Some comments made were, “ The manager was extremely helpful and pleasant when we came to visit. She was able to answer all our questions and much Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 9 more. This was very positive for us at that difficult time.” “ There was no more info really that we could be given when we visited. It was very helpful.” The files two people living at the home showed evidence was obtained on both before they were admitted to the home. Wishing Well DS0000015835.V372970.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 and 10 People who use the service experience good quality outcomes in this area. People’s healthcare needs are met and care plans provide good person centred instructions for staff to follow. Staff are aware of people’s needs and there is good communication amongst the staff group and with healthcare professionals. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The care files for two people living in the home were looked at. There some good personal care information seen within both files. They showed time had been taken to identify the personal care needs of each person develop a plan on how the staff were to meet these needs. Independence promoted within the documentation, which was good practice. Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 was that and was Page 11 The manager agreed that paperwork has not always been her strong point and that the organisation of the records could be better. However, these shortfalls were outweighed by the intensive knowledge the manager and staff had regarding the care needs of the people who lived in the home. Daily records of care were kept and records of when people saw a health professional were also recorded. Relatives spoken to were extremely confident that the people living in the home knew exactly what the care needs of their relatives were and always acted in their best interests. Some comments made were: “We were totally involved with planning dad’s care. We couldn’t give the home anymore praise. We are absolutely thrilled at getting dad placed in the home.” “They are aware of the care needs and we are always informed when he is not feeling so well or when he needs to see a professional.” “ The care and understanding she is given here is brilliant. There is excellent one to one quality care given. She is a changed woman since she has lived here!” People were well dressed and their hair was tidy. Relatives said the staff are very attentive to personal grooming in the home. One lady living there said that the manager always did her hair for her when she wanted. This was observed during the day. The lady was going out with a relative and she sat with the manager who did her hair for her. Both appeared to enjoy this interaction and there was plenty of conversation and jokes shared. One relative said, “This home is a place where individuals are helped to live a life as close to that one they left when they lived in their own family home. They are supported to live as independently as they can in an unobtrusive way.” People spoken to spoke highly of the staff group when it came to promoting privacy and dignity within the home. A good proportion of time was spent during the inspection visit watching staff practices. This showed that they know the care needs and personal preferences of individuals and are good at identifying non-verbal behaviour that indicates when a resident is happy or unhappy. They were good at making sure nobody was isolated and got as much positive attention as possible. The relationships between staff and the people they care for were warm and friendly with people obviously enjoying some physical reassurance like holding their hand as staff spoke with them. Examples of some comments made were, “The staff are always respectful. I come here regularly and they have been very helpful and pleasant to everyone.” “They are very aware of personal hygiene needs and are respectful with regards to people’s privacy when it’s needed.” Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 12 Medication is stored in a locked cupboard in the dining room making it easy to administer drugs at appropriate times. The home uses a monitored dosage system – drugs dispensed in blister packs by the pharmacy. The systems of ordering, checking in and disposing of drugs was discussed and records were checked. The lunchtime medication was administered properly and recorded. The drugs administration charts showed no omissions. Wishing Well DS0000015835.V372970.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 and 15. People who use the service experience excellent quality outcomes in this area. People’s social expectations and personal preferences are met and they are assisted to exercise choice in their daily routines. People living at the home are provided with a varied and nutritious diet. People living in the home are provided with a variety of activities to suit their needs. The standard off food provided by the home is good. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The person centred approach of the home means that where possible activities are individually organised. The manager tries very hard to ensure people’s leisure activities are suited to their needs. She has ensured that musical and television tastes are well catered for, by buying specific items according to the people’s preferences. The manager has provided a number of entertainment Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 14 outlets that people are actively involved in, including CD’s, books, games and DVDs. People are able to get involved with the daily chores around the house. The manager feels it is important that the residents can still contribute to the running of the household if they wish. The manager takes people to the east coast on a regular basis throughout the year, more frequently in the summer. This was confirmed through conversations with the relatives of people who live there. Evidence was seen to show the home provides an environment that is people centered. The manager said that residents always do well when they arrive here and improve greatly. A relative of one of the people living there said that the home had worked wonders for her relative. She said, “ They have got her to enjoy life again.” Conversations during the visit confirmed that there was a strong person centred care approach to involving individuals with leisure and social activities. The manager said the home offers plenty of diversity within the home life. She said they listens closely to feedback from people’s families and friends as well as the residents themselves. She said they always listen and try to involve people in all daily living activities for example, residents help with choosing the food on the shopping list to suit their personal tastes. People may choose to wash up a few dishes or fold some of the clean laundry. The manager feels it is important that the residents can still contribute to the running of the household if they wish. This was confirmed through conversations with relatives. There are lots of photographs in various parts of the home, which provide talking points about previous events and evidence of enjoyable times in and out of the home. The home has a number of animals, which also provide diversion and entertainment. The gardens around the home are excellent and very sensory in design. These allow people to interact with the outside as well as inside. People said that they used the gardens a lot, especially during the summer time. People are supported to maintain contact with family and friends. Visitors spoke highly of the way the home promoted these contacts. They said it was like ‘home from home.’ All people spoken to were very complementary about the food offered by the home. The food is home cooked and wholesome in appearance. People said their likes and dislikes were taken and these were regularly incorporated into the menu. Relatives said meals were exceptional. They were social events and people were assisted to eat when it was needed. The tables were very well presented and had many condiments. Wishing Well DS0000015835.V372970.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 and 18 People who use the service experience good quality outcomes in this area. The people who live at the home and their relatives feel confident that they will be listened to and things made better when necessary. People are assured that they feel safe at the home. There are adult protection procedures in place that staff have awareness of and understand. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: There have been no complaints to the home or Commission since the last inspection. The complaints policy is displayed in all the bedrooms, as well as in the Service User guide, which is given to residents and their families. Family members, who are able to check on their welfare, also visit regularly. They all said that they had no reason to complain but if they had they would have no hesitation speaking to the manager who they all found very helpful and approachable. Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 16 The manager has good knowledge and understanding of what indicators might suggest one of the service users has been abused. She also outlined her responsibilities, as a manager, if this situation were to occur. One member of staff has been recruited recently. There is an adult protection procedure and staff have access to this and have received training. The manager has attended workshops on the Protection of Vulnerable Adults and trains staff in the home on this topic. Relatives were very positive about the protection issues in relation to their family members. They all said they felt their relatives were well protected whilst living in the home. Wishing Well DS0000015835.V372970.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 and 26. People who use the service experience good quality outcomes in this area. People live in a safe, comfortable and well-maintained environment. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The building is a semi-detached house that has been extended. On the day before the inspection carpet fitters had been and put a new carpet in the hallway and stairs. Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 18 The environment is domestic and homely. Furnishings and fittings are of good quality and the building is well decorated. Where changes are planned, like the conservatory or redecoration, these are discussed with people living at the home so that they can feel involved. Bedrooms are decorated to their personal taste with coordinated curtains and bedding. Bedding is replaced regularly and any new person always benefits from new bedding. This is good practice and promotes dignity and choice. The bedrooms are personalised with furnishings and belongings like photos and ornaments belonging to individuals. The home owners live in a loft conversion at the top of the house. This is linked to the emergency call system so that if anyone needs assistance during the night the owners are alerted. The manager said this is explained fully to the prospective people and their relatives There is no stair lift, so residents have to be able to manage the stairs. There is a made to measure safety gate at the top of the stairs that is used at night for additional safety. People can assist in the kitchen but this is always under supervision to reduce risks. The kitchen has been extended and adequately caters for the needs of the home and can provide an additional space for people to come in and have a chat with staff at the kitchen table. The gardens to the rear of the building are a good size and are safe for people to sit out and wander around. There is a patio area, a summerhouse, a dovecote, bird tables to provide interests for people and well-kept flower borders and a barbeque area. Wishing Well DS0000015835.V372970.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 and 30. People who use the service experience good quality outcomes in this area. An experienced staff group cares for people living in the home. Improved recruitment procedures are needed to further protect people. We have made this judgment using a range of evidence, including a visit to the service. People living in the home are cared for by experienced staff who are recruited properly and trained for the job. EVIDENCE: The manager, with the help of her husband and one part time carer provide 24 hours support for the residents. People said staff were available whenever they needed someone. Staff have time to sit and talk with the people and discuss future events and meal preferences. There was a new member of staff on duty during the day of the inspection and she was working closely with the manager. She confirmed that she was on an Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 20 induction period and that her induction was filed in on a daily basis. She had been given a full introduction to the home and the equipment used to provide care. She is in need of food hygiene and infection control training to ensure the safety of people living there. This carer does not give medication, as she has not yet had the training. She has been introduced to the homes policies and procedures. The recruitment file for this care was reviewed and it was found that one reference had still not been obtained prior to commencing work. During the inspection visit a large part of the time was spent in the communal areas watching staff at work including during the mealtime. There were enough staff on duty with the manager and a carer. This allowed people to get plenty of individual attention, support and encouragement with a lot of checking to see if they were happy. Relatives spoken with were very happy with the numbers of staff that were on duty to provide for the care needs of the people living in the home. They were very complementary also about the competency of the staff to deliver the care in the home. Wishing Well DS0000015835.V372970.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 and 38. People who use the service experience good quality outcomes in this area. The home is well managed. The interests of the people who live there are seen as very important to the manager and her staff. There is a clear approach to care that is person centred and puts the best interests of individuals central to staff practice. Regular auditing and checking of facilities, equipment and services make sure the home is a safe place to live. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 22 The manager has owned the home for several years and is very experienced in caring and supporting older people. She has a very good relationship with the people who live in the home and their family and friends. She finds out their views about the service, and those of their family informally in conversation, but there is also a completed small questionnaire in their service files. The home does not have any responsibilities for holding service users’ monies, and if the manager buys items on behalf of a person, the cost is invoiced to the family. People have lockable items of furniture to keep valuables and can lock their rooms if they wish. It was clear from speaking with people that the manager is a good leader and well respected. The manager has owned the home for several years and is very experienced in caring and supporting older people. The manager indicated that relevant health and safety and infection control policies and procedures are in place, and that regular checks are made of facilities and equipment. There were risk assessments in place for the environment. The owner’s husband holds the responsibility to check the fire system each week and conversations with people confirmed that this is done. Wishing Well DS0000015835.V372970.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 3 x 3 x x n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no 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 Standard OP29 Regulation 19(1)(4) Requirement Two written references must be obtained before a person can work with vulnerable people Timescale for action 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP30 Good Practice Recommendations Care plans and risk assessments should be reorganised so there is a clear plan of care in place for each individual. Staff training records show that staff will be due up dates in safe working practice training. The manager should now start arranging for this to be done so everyone is up to date. Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Wishing Well DS0000015835.V372970.R01.S.doc Version 5.2 Page 26 - 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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