Ratings for care homes and domiciliary support services - seven months on

New regulations

Section 37 of the Regulation and Inspection of Social Care (Wales) Act 2016 (RISCA) introduced regulations that allow ratings to be given following an inspection. 

After a pilot phase with silent ratings and a period of consultation, these regulations were put into effect through the Regulated Services (Inspection Ratings) (Wales) Regulations 2025. 

From 1 April 2025, CIW began publishing ratings for care homes (for children and adults) and domiciliary support services. 

This report looks at the first seven months of ratings and how these have been implemented. 

The benefits of ratings

• Ratings provide clear, consistent, and transparent assessments of care quality, helping people, families, and professionals make informed decisions about social care services.
• They offer an accessible overview of service quality, supporting confident choices and informed discussions with providers.
• For providers, ratings highlight strengths, motivate continuous improvement, and showcase high-quality care, boosting staff morale and aligning with regulatory standards.
• Ratings encourage services to focus on outcomes for people, supporting ongoing improvement and the pursuit of excellence.

What does the data tell us so far? 

Between 1 April and 31 October we have inspected 578 services: 

• 310 - care homes for adults
• 117 - care homes for children
• 151 - domiciliary support services

Following the 578 inspections, we have published ratings for 566 services: 

Domiciliary support services do not receive a rating for ‘Environment’.

The data shows of the 2,115 ratings awarded, 1,958 (92.5%) were excellent or good presenting a positive picture for services across Wales. This suggests there is a consistently high standard of care across the sector, with strong evidence of good and excellent practice.

Only a small number of services require significant improvement. Where improvement is needed, it most often relates to the leadership and management of the service. 

Care Inspectorate Wales is committed to ensuring everyone in Wales receives safe, high-quality care and support. We will not hesitate to take action where services fall below the standards expected.

Feedback from providers

We have been encouraged by the feedback we have received from providers. 

• “The inspection process was thorough, focused on the most important aspects of the four themes and conducted in a way that was transparent, inquisitive and not overly judgemental. It also proved that CIW very much wants our home to succeed”.
• “The inspector maintained a respectful, objective and balanced approach throughout the inspection process. We felt we had the opportunity to be listened too and never rushed. To have an inspector who is approachable and respectful helps build trust”. 

What does CIW look at during inspections?

Working with a range of providers of care homes and domiciliary support services, CIW revised its inspection framework to include clear descriptions of quality linked to ratings.

The focus of our inspections is on people’s experiences of care. We assess the quality and safety of services and the outcomes for the people using services. We consider four themes during inspections:

• We assess how well people receiving care and support are doing, focusing on whether they are achieving positive outcomes in their lives.
• We examine the quality of care and support provided, checking that people receive a high-quality service delivered by knowledgeable and skilled staff, and that the care helps people achieve the best possible outcomes.
• We look at the physical setting where care and support are provided, ensuring that people live in a home that is safe, clean, comfortable, welcoming, well-maintained, and suitably equipped and furnished.
• We evaluate how the service is organised and managed, considering whether the arrangements in place ensure high-quality care is delivered by motivated staff in a well-led and managed service.

Ratings descriptors

Under each of the four inspection themes, we have developed lines of enquiry. We have developed descriptions under these for each potential rating to guide service providers and inspectors. 

We award a rating for each inspection theme. We do not award one overall rating for the service as a whole. 

Excellent

An “excellent” rating means, with few exceptions, the service is outstanding. This could be for exceptional leadership, for care and support that puts people at the centre of everything they do, or for making a significant positive difference to people’s well-being.

“The relationships between children and staff are clearly positive and trusting. There’s a real sense of fun, laughter, and care throughout the home. The team works in a trauma-informed way, combining a gentle, caring approach with clear boundaries and guidance. This helps the children feel safe and secure”.

“Staff don’t shy away from difficult conversations. They always take the time to explain what’s happening and what’s expected, making the home a predictable and reassuring place for the children”.

Good

A ‘good’ rating means the service is consistently safe, caring, and meets people’s needs through reliable practices with positive results.

“Residents experience a strong sense of well-being through a person-centred approach that values dignity and choice. Inspectors observed positive interactions between residents and staff, with everyone engaging in meaningful activities like swimming, museum visits, and community outings”.

“The home is comfortable and adapted to residents’ needs and tastes, with personalised bedrooms and welcoming communal areas that foster independence and provide ample space for activities and relaxation”.

Requires improvement

This rating means the service sometimes falls short of expected standards with inconsistent practices and areas that need strengthening to ensure people’s safety and well-being.

“Risk assessments aren’t thorough enough and they don’t clearly show the risks to children or how those risks will be managed”.

“Some plans we viewed lacked sufficient detail and did not fully reflect people’s needs or outline clear measures to manage identified risks. Although personal plans are reviewed monthly, there is limited evidence of involvement from people or their representatives in the review process”.

Requires significant improvement

This rating signals that the service is rarely effective, has weak or inadequate leadership, and significant gaps in care that risk people’s safety and wellbeing. It means the service provider must take immediate action to make improvements.

“Daily records indicate that care is not being delivered in line with assessed requirements, compromising both physical and emotional wellbeing. Some staff are working with individuals without full awareness of their specialist needs, which increases the risk of inappropriate care delivery”.

“The provider has not established sufficient oversight to ensure the smooth operation of the service or the delivery of high-quality care. Governance and performance management remain weak and unreliable, resulting in inadequate systems that have failed to identify and manage significant risks”.

What’s next?

We will continue to support our adult and children’s service providers through the roll-out of ratings. Once ratings are embedded and all relevant services have received their ratings (by Autumn 2026) we will conduct an independent review. This review will enable us to better understand how ratings are working in practice, what trends we are seeing across the sector and what further support is needed. 

'Excellent' examples:

Tŷ Llandaff Care Home: A journey to excellence

The challenge

In October 2022, the 70-bed care home in Cardiff faced significant hurdles. Heavy reliance on agency staff undermined consistency and continuity of care. 

External stakeholders had raised concerns about care standards, and low occupancy meant substantial parts of the home had been closed for several years. The service needed strengthened leadership, improved workforce stability and a renewed focus on quality outcomes.

The approach

The home embarked on a steady, sustainable transformation journey:

• Building a permanent team
• Investing in staff development
• Strengthening external relationships
• Embedding continuous improvement
• Prioritising person-centred care 

The impact

The transformation delivered measurable improvements across all aspects of care:

• Reduced hospital admissions – One resident with a complex long-term condition had no unplanned hospital admissions for over six months after strengthened clinical oversight
• Enhanced mobility and independence – A resident progressed from requiring two-person assistance to safely mobilising with one carer after a personalised exercise plan
• Improved emotional wellbeing – A resident experiencing social withdrawal now attends daily activities and reports "feeling part of things again"
• Dignified end-of-life care – Families consistently praise the home's palliative care, with one relative describing their loved one's final weeks as "peaceful, dignified and free from distress"

The result

In recognition of sustained improvements in quality, safety and outcomes, CIW awarded Tŷ Llandaff an 'Excellent' rating across all four themes The home now operates at full capacity with a stable team of around 120 permanent staff, strong stakeholder confidence, and residents who thrive physically, emotionally and socially.

Key lessons

• Start with leadership – Clear vision, consistent oversight and visible support drive cultural change
• Invest in your workforce – Professional development, recognition and a supportive environment create engaged, motivated teams
• Build partnerships – Collaboration with regulators, commissioners and community services accelerates progress
• Keep residents at the centre – Involve them in care planning, communicate openly and act on feedback
• Be patient and persistent – Sustainable transformation takes time, but celebrating milestones whilst focusing on long-term outcomes delivers lasting results

What families told us 

• "Staff and the home are absolutely super and marvellous"
• "Tŷ Llandaff is off the scale in a good way"

From potential to excellence: How Blaen y Waun Children's Home transformed care

The challenge

When Priority Childcare's Responsible Individual took oversight of Blaen y Waun in 2021, the two-bed children's home had caring staff but lacked structure and consistency. Care planning was inconsistent, risk assessments were inadequate, and crucially, children's voices weren't heard in decisions about their own lives.

The turning point

The appointment of a dedicated home manager catalysed change. Working with regional and quality assurance managers, she built a confident team and embedded clear systems with strong accountability. The first months focused on stabilising the home and establishing a shared, child-focused vision through coaching and reflective supervision.

The impact

Within 18 months, Blaen y Waun became a safe, nurturing environment where children can thrive. The transformation is evident in:

• Improved wellbeing: Predictable routines and trauma-informed practice have enhanced the children's emotional health, behaviour, educational engagement and independence
• Empowered children: Young people now co-create their care, shaping routines, activities and decisions
• Confident team: Staff grew from inconsistent practice to delivering high-quality care with pride
• Regulatory excellence: All CIW regulations are now fully met, with robust oversight and clear systems

The key lessons

Real transformation required more than systems - it demanded strong leadership, team development, and genuine listening to children. The service learned that excellence isn't a destination but an ongoing journey of reflection, adaptation and evolution.

As the home manager demonstrates: success comes from never settling for "good enough" and continually asking what more can be done to help children flourish.