Cera - Wiltshire

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (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 consistently demonstrate a proactive, transparent, and positive approach to safety.

While staff listened to safety concerns and took steps to investigate and report incidents, learning from these events was not always embedded by leaders to drive continuous improvement. For example, although there was an incident tracker, it lacked essential details such as actions taken, follow-up requirements, and the outcomes. These shortfalls meant the provider could not evidence lessons were learned or that preventative measures were implemented. This increased the likelihood of recurring safety issues and reduced confidence that improvements would be sustained.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported to review their own discharge plans and helped to update their support plans. Where people were unable to do this we saw evidence that the provider had consulted with relatives to ensure people’s care needs would be met. This care planning ensured all health care staff had a good understanding of a person’s needs to ensure continuity of care. People told us “following my discharge from hospital, the provider helped me settle back into my own home with increased support”.

For people who were looking to start care from the service, care planning documents demonstrated people were put first. For example, the provider had thought about how people would feel and what support they would need to move between providers. Specific comments included “[the care planning documents] were in place from the previous care company but Cera staff sat down with me and went through my needs to make sure nothing had changed”.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt secure in their homes and staff actively promoted their safety. Every staff member we spoke with demonstrated safeguarding principles and shared practical examples of how they protected people during care delivery. They spoke confidently about identifying signs of abuse and described the steps they would take to safeguard individuals.

The provider had an electronic system for training and a designated person in charge for ensuring training compliance. All staff had completed safeguarding training, and records confirmed refresher sessions were booked for staff who required them.

People using the service and staff understood how to escalate concerns beyond the management team. People’s comments included: “I know how to raise a concern and then if I am unhappy, I can raise it with safeguarding or the Care Quality Commission (CQC)” Staff described [what they would do if concerns were raised, stating] they would report unsafe practices to their line manager if observed during care delivery. Comments included, “I would report everything to my manager, no exceptions” and “I would whistleblow if I had any concerns about the company”. Staff were clear on external contacts should internal responses fail to address concerns effectively.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had risk management plans that did not contain enough detail to guide staff in providing safe and consistent support. For example, one person was at risk of developing pressure ulcers. However, the guidance available to staff did not explain how to reduce this risk or consider other relevant health conditions that could contribute to skin breakdown. The information did notoutline how staff should monitor the person’s skin, what signs or symptoms of deterioration to look for or when concerns should be escalated.

Another person who was at risk of displaying distressed behaviours, which had been recognised at assessment had no clear guidance for staff on the potential triggers or the support strategies to use. This meant that although some support and guidance was in place, further work was required to fully involve people in managing risk.

One person had been identified to have a nut allergy, but there was no information regarding the level of potential reaction, treatment, or escalation plan. This was raised with the regional manager on the day of inspection. Managers took immediate action to rectify this.

Another person had a diagnosis of asthma. Although there were some measures to support breathlessness, the guidance did not include any information about the signs or symptoms of an asthma attack, nor did it outline an emergency procedure for staff to follow. This meant systems were not always safe and did not always protect people from harm. We raised this with the provider who took immediate steps to add a risk assessment and produced guidance for staff with the use of inhalers.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider assessed the home for risks and took action to ensure people, staff and visitors remained safe. People had individualised environmental risk assessments which detailed hazards in their home. This included flammable emollient-based creams and how to safely support people in the event of an emergency.

People told us they felt safe in their home, comments included: “I have a risk assessment because I use creams and I am a smoker. Staff are always reminding me not to smoke directly after having creams applied” and “Staff are great at securing my house…this makes me feel safe even after carers have left for the day”.

People told us that the provider had supported them with technology such as lifelines. Comments included “these resources contribute to my feeling of safety out of hours”.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.  The provider did not consistently ensure that care visits were delivered on time, which impacted the reliability and safety of the service. At the time of our assessment, the service achieved an average of 74% rate of on-time visits over three months. While this was increased from the previous quarter of 71%, this shortfall posed a risk to people’s safety and well-being, particularly for people who required time-sensitive support such as medicines administration or assistance with mobility. All people told us they had experienced late visits, managers confirmed they were working to further reduce late visits by looking at factors such as runs and traffic, however this was not documented in the provider’s improvement plan.

Some people told us they had some concerns over staff knowledge and consistency. Comments included: “My regular staff are great, and they know how to support me, but newer staff are sometimes unsure of how to perform tasks” and “I have had 4 different staff today for each of my visits who I have never seen before”. We shared this with the provider who made arrangements to review this.

Pre-employment checks had been completed for staff before starting work. New staff received an induction, including shadowing experienced staff. Staff told us they received regular training. During the assessment, we observed a group of new staff being inducted. Comments included “Training here seems in-depth and interesting” and “I have worked in care for a number of years. This is the most thorough training I have ever done”.

Staff had undertaken specialist training specific to autistic people. This meant staff were better equipped to understand people’s communication styles, sensory needs and preferred ways of receiving support. This enabled more consistent, person‑centred care and support.

On-call staff were used to cover any staff sickness and staff also told us that managers stepped in to cover shortfalls. This minimised the risk of any missed visits although people told us that they did not always know who was coming to deliver care.

People and their relatives told us there were enough staff to meet their needs, including support for them to attend last minute appointments.

The provider assessed and managed the risk of infection and told us they would raise anything with appropriate agencies promptly.

Staff completed infection prevention and control (IPC) training and told us they had access to all the personal protective equipment they needed.

We saw evidence of completed IPC spot checks and staff spoke about the importance of maintaining hygiene standards. People confirmed that staff supported them safely and used personal protective equipment (PPE) when needed. One person said, “Staff are great, they always put their gloves on” and “Staff wear PPE when they support me with showering and hair washing”. These statements reflected the provider’s commitment to maintaining a safe and hygienic environment.

Meeting records demonstrated leaders regularly reinforced the expectation for staff to maintain clean and professional uniforms as part of IPC standards. This was discussed to ensure good hygiene, reduce the risk of cross-contamination, and present a professional image when delivering care.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning their medicines support, including when changes happened.

People told us staff provided good support for them to take their medicines. Staff had completed training in the safe management of medicines and leaders regularly observed their practice through spot check visits. These and medicine audits ensured staff knew how to dispense and administer medicines safely.

People were supported to have regular reviews of their medicines with their doctor. The provider was working in line with “Stopping Over Medication of People” (STOMP) guidance. This ensured people were not prescribed more medicine than necessary.

Medicines errors were recorded and escalated in line with the provider’s policies and procedures. Each person had a medicines risk assessment which detailed level 1, 2 or 3 administration. This meant people’s medication profiles clearly defined what level of support people required with their medicines. This was in line with the National Institute for Care Excellence (NICE) recommendations of best practice. People had body maps for emollient application and references to the risks of flammable based emollients. Medicine Administration Records (MAR) showed all prescribed medicines, including topical creams, were administered as required. This ensured people received the correct medicines at the right time, promoting safe care delivery.