- Homecare service
Cera Castleham Lodge
Assessment report published 12 May 2026
Contents
Ratings
Our view of the service
Cera Castleham Lodge is a domiciliary care agency. It provides personal care to people living in their own homes in an extra care scheme. Not everyone using the service received a regulated activity; CQC only inspects the service being received by people provided with 'personal care' such as help with tasks related to personal hygiene and eating.
We carried out this assessment as we had received some information of concern. At the time of this assessment, 16 people were receiving personal care from the service. We completed an onsite visit over 2 days. We assessed all quality statements under the 5 key questions: Safe, Effective, Caring, Responsive and Well-led. We found 6 breaches of the legal regulations in relation to safeguarding, safe care and treatment, person-centred care, complaints, staffing, and governance. At this assessment, the overall rating was requires improvement.
The absence of robust governance processes and oversight resulted in the provider not previously addressing the service failings which our assessment highlighted. There were ineffective quality assurance processes in place to ensure managers had the skills and appropriate level of support to turn around a service struggling with multiple quality issues.
People described some staff “as over their heads” and “trying to do the best they could ”while being under “intolerable pressure.” There had been a lack of consistent managerial oversight in the last 12 months, although a new manager started in January 2026 which was hoped would stabilise the service.
Governance processes failed to address concerns raised by care staff regarding poor oversight and management of rotas which resulted in “call cramming”, missed visits and delayed visits to people. Since the provider had taken over the service, staff retention had been an issue both at care staff and manager level. This put significant pressure on the remaining care staff who felt responsible for the well-being and safety of people using the service without appropriate managerial support.
Risk assessments and care plans were not routinely reviewed with people. Not everyone had a care plan produced by the current provider.Improvements were also needed in safeguarding and the oversight of medicine concerns. Some aspects of involving people in making decisions also needed improvement to protect people’s legal rights.
Staff were mainly up to date with their training. However, staff supervisions had not been a regular occurrence. Staff said they had not always felt listened to when they raised concerns, and the complaints system lacked a robust approach to ensuring people’s concerns were recorded and addressed.
Despite the above, there was a core team of care staff who were committed to maintaining a service for people and therefore stayed out of loyalty. New care staff had been recruited and were being inducted to the service during our assessment.
We met a member of the management team who was committed to improving and supporting the staff and people at the service. However, we noted this role was in addition to other responsibilities for other services too, including ones where there were similar problems to resolve.
In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.
People's experience of this service
People said they felt safe with the staff group but at times the service seemed unsafe due to missed visits, delayed visits, or a lack of consistency with changing agency staff.They told us some staff were very experienced and knew their care needs well, and how they liked things to be done. However, they said they constantly had to repeat how they liked their care to be delivered to new staff.
People said care staff were kind and caring. However, a person described how their dignity and privacy was sometimes impacted.
People told us they were saddened by the loss of experienced staff since the service had been taken over by the provider. People said the changes of care staff took a toll on their well-being and their confidence in the running of the service.
People were happy with staff practice around infection control. People who spoke with us about the service, generally managed their own medicines and had no concerns. They said staff asked for their consent before they carried out personal care tasks and we saw staff checking if they could enter people’s flats.
People said care plans were not being effectively monitored and reviewed. This potentially put people at risk as it meant deteriorating conditions or increasing concerns were not being addressed.
People told us the service was not always responsive when they raised concerns about their care. They said they were tired of hearing there would be improvements in the management of the service when for many months this had not been forthcoming. However, during our visit to the service, interim management arrangements had begun to address late reviews, which people said was a positive change. New staff had been recruited and managers told us this would allow the service to stabilise and gain people’s trust again.