CQC report explained · a residential care home
What the CQC found at St Raphael's
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough suitable staff, effective safeguarding arrangements, safe medicines management and appropriate risk assessments. A small number of environmental risks were identified and addressed immediately.
- Effective?
- Good
- Staff were trained and experienced, and people received support with food, drink, healthcare and their individual conditions. The home was working within the principles of the Mental Capacity Act.
- Caring?
- Good
- People were treated with kindness, privacy and dignity. Staff supported people to make choices, express their views and develop their independence.
- Responsive?
- Good
- This key question was not inspected during this visit, so the report gives no new rating for it.
- Well-led?
- Good
- The home had effective checks and audits, a positive culture and staff who felt supported to raise concerns. Managers worked closely with staff, people living at the home and other professionals.
What inspectors found, October 2022
St Raphael's is rated Good; inspectors found safe, kind and person-centred care, with improvements since the previous inspection.
This was an unannounced focused inspection on 18 October 2022. Inspectors observed care, spoke with people and staff, and reviewed care records, staff records, medicines records, audits and other management information.
The home was rated Good for Safe, Effective, Caring and Well-led. Inspectors found enough suitably skilled staff, safe medicines practices, good support with health needs, kind care, respect for people's choices and effective management systems.
The previous rating, published in November 2021, was Requires Improvement. The provider had been asked to make changes after breaches relating to staffing, staff training and governance. Inspectors found enough improvement had been made and the home was no longer in breach.
This inspection did not cover Responsive. The overall rating used the new findings together with ratings carried forward from the previous inspection.
Kind and respectful care
Inspectors saw staff communicate patiently and respectfully. People had good relationships with staff and were supported to express their views.
“We observed the staff treated people with kindness.” from the report
Safer staffing
The home had enough staff to meet people's needs. Regular temporary workers knew people well and provided continuity of care.
“There were enough suitable staff deployed to keep people safe and meet their needs.” from the report
Improved management
Quality checks and audits were being used effectively to identify improvements and track actions. The home was no longer in breach of the regulations identified at the previous inspection.
“There were systems to monitor and improve the quality of the service and these were operated effectively.” from the report
Environmental risks
minorInspectors found a small number of potential risks in the environment. These were reported to the manager and dealt with immediately.
“We found a small number of potential risks within the environment which we made the registered manager aware of and they addressed immediately.” from the report
- 01How do you make sure the improvements to staffing and training continue?
- 02How many staff vacancies are there now, and how often are temporary workers used?
- 03How do you check that temporary workers know each person's needs and care plans?
- 04What checks are in place to make sure environmental risks do not happen again?
- 05How do you review whether care remains responsive to each person's changing needs?
This was a focused inspection of Safe, Effective, Caring and Well-led; Responsive was not inspected and the overall rating also used ratings carried forward from the previous inspection. This explanation was written from the published report of 29 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2021
Requires Improvement; inspectors found kind, personalised care and safe medicines, but staffing, staff skills and quality checks were not reliable.
This was an unannounced inspection on 29 September 2021. Inspectors spoke with people, relatives, staff and professionals. They observed care, checked records and medicines, and inspected part of the building, including infection control.
The home had improved since the previous inspection, especially in personalised care. People were generally happy, enjoyed activities and had good access to healthcare. Medicines were managed safely, and complaints and incidents were recorded and reviewed.
There were still important problems. Vacancies meant the home relied heavily on temporary staff, and people sometimes waited for care. Some staff lacked advanced training for people's communication and healthcare needs. Inspectors also found risks that had not been fully assessed and quality checks that had not worked effectively.
The overall rating stayed Requires Improvement. Safe, effective, caring and well-led were rated Requires Improvement, while responsive improved to Good. The home was in breach of regulations about staffing and good governance.
Safe medicines
Inspectors found medicines were stored, administered and recorded safely. They found no unexplained omitted doses in the charts they checked.
“Medicines were safely managed. There were systems for ordering, administering and monitoring medicines.” from the report
Personalised care
Care plans had been updated with people's preferences and guidance about their needs. People and relatives said their needs were met and they could make choices.
“People received personalised care which met their needs.” from the report
Kind relationships
People were generally happy and relaxed. Staff were described as kind and caring, and inspectors saw friendly relationships and people enjoying activities together.
“Staff were kind, polite and gentle when they spoke with people. They had friendly relationships with them.” from the report
Activities and community
People took part in a range of social and leisure activities and were supported to see relatives and friends. The home had a strong sense of community.
“There was a sense of community, and people enjoyed spending time with each other.” from the report
Too few permanent staff
seriousThere were many vacancies and heavy reliance on temporary staff. People were not always supported by staff who knew them well, and someone had to wait for care.
“Failure to deploy sufficient numbers of staff was a breach of Regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Staff skills
seriousSome staff had not received advanced training to meet people's communication and healthcare needs. Inspectors found this meant people's needs were not always being met.
“Failure to deploy suitably qualified and experienced staff meant that people's needs were not being met.” from the report
Quality checks
seriousThe provider's monitoring systems had not identified or fixed all the staffing, environmental and care problems. This was a continuing breach of good governance requirements.
“Failure to effectively operate systems and processes for monitoring and improving quality was a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Environmental risks
needs fixingSome items in unlocked bedrooms could potentially be misused, and some bathroom alarm cords were not accessible. The provider agreed to assess these risks.
“There were some risks within the environment which had not been assessed.” from the report
A delay in personal care
needs fixingInspectors saw one person wait for continence care and be left uncomfortable. Staff and managers accepted this was not acceptable and said they would look at preventing it happening again.
“During the inspection, we witnessed one person had to wait to be supported with continence care.” from the report
- 01How many permanent staff vacancies are there now, and how often is temporary agency staff used?
- 02What advanced training have staff completed for communication, dysphasia, positive behaviour support and people's healthcare needs?
- 03What action has been taken to make sure people do not wait for continence care or other personal care?
- 04Have the risks from unsecured creams, vapour rub and denture tablets, and tied-up alarm cords, now been assessed and addressed?
- 05What improvements have been completed under the action plan for Regulations 17 and 18, and how are they being checked?
This was an unannounced planned inspection covering all five CQC questions, including infection prevention and control, with medicines, records, care and part of the environment checked. This explanation was written from the published report of 10 November 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of St Raphael's
6 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- October 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2021Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementWell-led: Requires improvement
- November 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- October 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 28 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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At least 100 live-in carers within about an hour of Hounslow
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,270 a week. 85 can care for a couple. 11 years' experience on average.
“Without his support we wouldn't have been able to navigate bringing and keeping Dad at home.”
“I can truly say that Peter always put Dad at the centre of everything and I know that they found a great friendship in difficult times.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.