Cera - Wiltshire

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

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

This meant people’s needs were met through good organisation and delivery.

This service scored 64 (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 made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

During the assessment, the provider shared some examples of person-centred care. This demonstrated they were committed to supporting people in a holistic way. For example, one person was supported to access the community to maintain existing friendships at local events. The person told us: “My carer doesn’t just take me but actually gets involved in the activities as well”. They told us the impact of this was that having the carer participate was more like an extension of their friend circle.

Staff cooked Christmas lunch for people and took it to their homes. Staff told us this was to ensure that people would have a Christmas dinner to look forward to on the day. People told us the impact of this meant “because I can no longer cook, I could enjoy Christmas dinner just like I used to”.

The provider understood the diverse health and care needs of people and their local communities. Care was joined-up, flexible and supported choice and continuity.

Staff and leaders kept professionals up to date with any concerning information about a person’s wellbeing. They were also invited to care reviews, which enabled coordinated and improved support for people. This meant professionals supporting the person had accurate, up‑to‑date information, and everyone involved in their care could work together effectively to make sure the person received the right support at the right time.

Leaders were knowledgeable about people’s diverse health and social care needs. They gave examples of these and explained how other professionals were involved to ensure the person’s wellbeing. For example, managers described one person who lived in an “at risk environment”. They said they regularly liaised with other professionals about this, to ensure the most appropriate support was being provided.

People told us the service worked well with other professionals when needed. This included local GP surgeries, the local authority safeguarding team, social workers and pharmacies.

Managers informed us of the monthly newsletter that was populated by office staff and distributed to all people who were supported. This included information such as business updates and what was happening in the local area.

The provider did not always ensure people and their relatives had access to clear, timely and accessible information about their care and support. For example, reviews were not always completed in a timely way with people. This meant people did not always have the opportunity to discuss their most up to date support or raise any concerns. People told us: “while I’m happy with my care and the provider is great, I haven’t been asked if anything has changed for me”.

We assessed people’s reviews that the provider had undertaken and found they lacked questions about the timing of visits and whether people were happy with these. 6 out of 11 people told us “I have not had a review”. This meant people were not always given the chance to comment on whether their visit times suited them, and the provider was missing important feedback about late or inconvenient visits. Without this information, patterns could not be identified, opportunities to improve people’s experiences were lost, and changes that mattered to people were not always made. The provider told us they would amend their reviews for people to include their feelings about visit times.

Some care plans we viewed lacked detail and information. For example, one person’s care plan stated “does not have a mental health condition” but their medication profile stated they had a diagnosis of depression. Another person’s care plan stated “can challenge verbally” but there was no information provided in the care plan to identify what action staff should take when supporting the person or how to mitigate these concerns. This meant important information about people was not always clear and accurate, and information lacked detail. Some people told us they had not seen their care plan. We spoke to the provider about this who assured us they would review all care planning documentation and risk assessments and ensure people had the opportunity to discuss and view their care plans with staff

The provider did however liaise with commissioners and stakeholders to ensure people received regular local authority service reviews. They said any changes identified were communicated promptly.

The provider used multiple communication methods to meet individual needs. This included phone calls, printed materials, and digital updates. For example, one person found it easier to telephone the office. Comments included “I can phone up and always get through and speak to the [office staff]” and “they understand that I am forgetful, they repeat things for me and send me things out in the post, so I do not forget”.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. For example, Six out of eleven people told us they had not seen their care plan. This meant people were not always involved with their care planning.

Some people told us they did not feel listened to. Comments included: “I have complained about not wanting a carer to return and they have sent them out again to me” and “They know I do not want male staff caring for me, I have told them over and over again and they still send male staff”.

However, 8 out of 11 people told us they were listened to. Comments included, “If I need anything I just let them know, I can’t remember anyone saying no to anything I ask for, they couldn’t do more for me, I have no complaints, I am listened to” and “They are excellent, attitude is excellent, nothing is too much trouble. They are efficient, they just get on with it, they ask me and they listen, I can’t fault them.”

The provider made sure that people could access the care, support and treatment they needed when they needed it. For example, the provider worked with a public organisation to ensure a person who lived at home with their family had the means to go on a short break away from the family home. With this joined up working approach, the person was able to enjoy a life that was free from barriers and which offered access to short breaks. The impact on the person was that they enjoyed accessing the community and spending time away from their family.

Assessments covering the accessibility of a person’s home and whether any adaptations, equipment or referrals were needed had been completed. The provider ensured that as well as people having access to services such as adult social care practitioners, family members also had equal access to requesting social workers and support from mental health services.

The provider worked to ensure people and their relatives received a fair and equitable service from stakeholders. Hospitals were challenged by the provider when discharge plans had not been completed. This meant people were safer when returning to their homes because staff had information that enabled them to provide the best support for people coming out of hospital.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff had completed equality and diversity training and respected each person as an individual. For example, one person was informed they would never walk again. The person expressed a wish to walk a few steps. The provider actively sought physiotherapy referrals for the person and ensured this was arranged. They worked closely with partner organisations to maintain continuity and follow-up, so the person’s needs were fully met.

People told us they were supported to access services to meet their healthcare needs. Comments included “The carers arrange for my medicines to be delivered”. This meant people felt confident their day‑to‑day health needs were managed well, and they had fair access to important treatments and appointments.

Policies included guidance on reasonable adjustments, preventing discrimination, and supporting people with protected characteristics. Staff told us: “I am given shifts which fit around my need to take public transport” and “The provider has a salary sacrifice scheme which means I can get a bike for riding to and from visits”. Leaders told us: “When planning care visits “We assess all staff on an individual basis” This meant staff were supported fairly and consistently, with adjustments made so everyone had an equal chance to do their job well. It also showed the provider considered individual circumstances when organising work, helping to create an inclusive environment where staff felt valued and treated with respect.

People were not always supported to plan for important life changes. This did not always allow them enough time to make informed decisions about their future, including at the end of their life.

The provider had put some end‑of‑life care planning documents in place, but these were not applied consistently. For example, several care plans did not record the person’s preferences or decisions about their end‑of‑life care, which impacted on people being supported in relation to significant life changes. Comments included: “I do not know if staff know what my wishes are”. This meant people were not always able to make informed choices about their future care, and staff did not have the information they needed to support people in the way they would want at the end of their life. Important wishes may have been missed, increasing the risk that people’s final stages of life would not reflect what mattered most to them or their families.

In addition, not all staff had completed training in end‑of‑life care. This meant there was a risk people might not have been supported to plan for key stages of their lives, including end‑of‑life care, in a timely and person‑centred way. The impact of this was that staff may not have had the skills or confidence to talk to people about their wishes, recognise when someone's health was changing, or provide the sensitive support people need at the end of their life. We discussed this with the provider who assured us that staff would receive end of life training and that some people may not wish to discuss sensitive issues relating to their changing health needs.