Cera - Wiltshire

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Assessments were not consistently reviewed or updated in line with the provider’s own policies and procedures. For example, one person had been assessed using the Braden pressure ulcer risk assessment tool (A simple checklist that helps staff work out how likely it is that someone might get a pressure ulcer) and was identified as being at “medium risk”.

The provider’s policy outlined anyone at risk of pressure ulcers should have a review within six months or sooner if required. We checked their care records and the assessment had not been reviewed since October 2024. This meant the person was at increased risk of developing avoidable pressure damage because staff did not have up‑to‑date information to guide their care. Without regular reviews of risk, the provider could not demonstrate they were monitoring the person’s changing needs or taking timely action to keep them safe

Another person was assessed as having diabetes but there was no further indication of what their needs were. People told us the impact of this was that “newer staff are sometimes unsure of how to support me”.

This meant that the providercould notdemonstrateeffective assessing of people’s needs.

The provider did not always plan and deliver people’s care and treatment in a personalised way or in partnership with them, including taking account of what was important and mattered to them.

Carerecordslackedessentialinformation about specific medical conditions that could significantly affect the person’s ongoing care and treatment,such as their history of blood clots.

Several other people had allergies. For example, one person’s care plan stated they had a nut allergy. Another person’s risk assessment stated they had diabetes. We spoke to people who told us about these health conditions. When we asked leaders, they confirmed? there was no evidence to support staff to understand the severity of this allergy or how to support a person with their diabetes. This meant staff did not have clear and comprehensive guidance needed to support the person safely, effectively and in the best possible way.

However, one care plancontaineda detailed biography outlining the person’s history, preferences, routines, likes and dislikes. Their moving and handling needs were clearly described, including evidence of the individual’s own input. Other care planning documents contained clear and useful guidance for staff.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people joined the service.

We saw evidence of the provider working with the adult social care team including social workers, mental health practitioners and health practitioners. Speech and language therapists (SALT), behaviour support teams, and the occupational therapy team had engaged with the service to ensure people’s changing needs were assessed. For example, the provider supported a person’s family with an application for respite care, and worked together with the respite service to ensure continuity of care. This meant the person was able to spend some time away from home, and to have time out of the house. Even though they were in a different environment, staff were able to support them.

During our assessment, we overheard several telephone calls where the provider was working with the local authority to support people’s discharges from hospital. We spoke to leaders who told us this was an important part of their roles as it ensured a collaborative working approach which was holistic to the person.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff were proactive in identifying changes in people’s health and took immediate action to ensure appropriate support. For example, when supporting a person with their shopping, staff noticed they had a lot of items which contained salt. [Person] told us “[carer] knows I have high cholesterol and gently reminded me that I had items with high salt content. They helped me find alternatives. [Carer] knows me so well.” The person told us the impact of this was that they felt empowered to manage their own health needs.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes for people were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

For example, managers routinely requested updates from other services involved with individuals. We saw managers requesting support from the adult social care team and from doctors. People confirmed this. Comments included “my carers help me make appointments I need”.

Care records contained regular reviews of the service provided. These were completed with people and contained their thoughts and comments. For example, staff described noticing a change to a person’s routine and how they contacted the office to ensure the changes were added to the care system.

People were involved in reviews about their support. One person told us “They’re really good. They know what I need and they ask me regularly if anything needs to change support wise”.

However, none of the service reviews contained opportunities for people to comment on the times of their care or to comment on late or missed visits. This meant the provider did not always capture people’s experiences of care visits which limited the provider’s ability to identify patters and make improvements based on people’s feedback.

The provider maintained records of team meetings and meetings with people. These detailed actions to ensure people were receiving effective support. For example, due to one person experiencing some ill health, staff had discussed introducing additional welfare check calls to them. The most recent team meeting discussed who would be on their own for Christmas and what the provider was going to put in place for them.

We saw records that welfare checks by telephone had taken place for several people where managers had identified wellbeing concerns. This demonstrated a proactive approach to safeguarding people and addressing issues before they escalated, as well as effective monitoring of individuals’ wellbeing to support improved outcomes.

The registered manager told us they regularly checked care records and completed observations to make sure support was provided in a person-centred way.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider could not evidence appropriate procedures for reviewing people’s mental capacity were being followed. For example, some care plans stated people lacked capacity, but no further information was available. Of the 7 staff we spoke to, 5 were unsure who had capacity to consent. Six staff told us information would be in care plans. We looked at care plans and people’s mental capacity had not been documented. This meant without documentation, staff would not know if a person lacked capacity about decisions and this also meant the provider was not able to demonstrate people were fully involved in decisions about their care and treatment. People told us “sometimes the newer staff think I cannot do things and think I cannot make decisions… surely it is in my notes somewhere that I am able to decide what I want and when I want it”. We spoke to the provider about this who told us they would undertake some work to ensure people’s consent and capacity was more detailed.

The provider told us that some relatives were listed as being next of kin for people. However, the provider did not have lasting power of attorney documents in place to demonstrate that people were able to act in people’s best interests from a legal point of view.

However, staff told us how they would ask people for their consent. For example, if personal care was required, all staff told us they would ask before providing support.