Archived: St Raphaels

Updated 28 January 2015

The inspection team comprised of an inspector, a specialist nursing advisor, a pharmacy inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience for this inspection was a carer of someone using this type of service.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We spoke with the local authority commissioner of services and the local safeguarding team to obtain their views. 

During the visit we spoke with 21 people using the service, eight relatives, two nurses, two senior carers, five care staff, a volunteer co-ordinator, two domestic staff members, a cook, the manager and the deputy manager for the service. We also spoke with the GP who was visiting the service during the inspection.

Not everyone at the service was able to communicate their views to us so we used the Short Observational Framework for Inspection (SOFI) to observe people’s experiences in the day. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We looked at areas of the building; we also looked at a sample of 14 records of people who used the service, five staff records and records related to the management of the service.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?’

The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.

Updated 28 January 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

We found that a new manager had been appointed in May 2014 and had recently applied to become registered manager. The previous registered manager had left some time previously and had recently submitted their application to deregister as manager for this service. A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law, as does the provider.

The last inspection took place on 27 and 29 November 2013, this was a follow up inspection related to previous breaches, to check that the service was meeting the regulations for medicines and care and welfare of people  and found the service met these regulations.

St Raphaels is registered to provide accommodation and nursing care for up to 58 people who have nursing or residential care needs. There are two units which accommodate 38 people in total with residential care needs and a unit for 20 people with nursing needs.

There were 48 people using the service on the day of the inspection. We found people’s safety was being compromised in some areas. There were inadequate procedures in place in case of fire. We have referred this to the London Fire and Emergency Planning Authority to assess if the provider was meeting required fire safety standards. We found the provider was not always meeting the regulations in relation to people’s consent to care and mental capacity assessments, the management of medicines and in their arrangements for emergencies. You can see the action we have asked the provider to take at the end of the full version of this report.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The service was reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS that had changed what was regarded as a deprivation of liberty. They told us they were in contact with the local authority about what action to take.

Risks to people were identified and reviewed when required and there were enough staff to meet people’s needs. There were adequate maintenance systems in place, and equipment at the service was checked regularly by staff or external contractors.

People told us they were safe, happy and well looked after. We observed good relationships between staff and people at the service and with their relatives. We noted staff took their time to interact with people in a meaningful way and treat people with dignity and respect. There was a range of activities available which people could chose to join in with.

Staff had adequate training to carry out their work and support people according to their care plans. People’s health was monitored and they or their relatives were involved in planning their care. People had enough to eat and drink and those who required support with their diet were identified and plans put in place to meet their needs. People were consulted about the service and they knew how to complain if they were unhappy.

The new manager had made some improvements and identified the need for further changes at the service. Most of the staff we spoke with were positive about the changes and felt the service had improved. There were systems in place to monitor the quality of the service and learning or actions identified; although these were not always consistently put into practice. While we could see that progress had been made there were still some improvements required.