Cera - Wiltshire

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders and staff demonstrated a clear vision that placed people at the heart of everything they did. Staff told us since the new registered manager’s appointment, there was an emphasis on the provider’s values of compassion, competence and communication. This newly defined mission statement had been well-defined and the provider was in the process of embedding it into everyday practice. Staff confidently and positively spoke about the organisation’s goals and described how it shaped their approach to care. Comments included “The mission statement is to provide high quality care that is compassionate and tailored to the individual person” and “The office is open, as a team we are open and transparent, all working toward the same goal”.

Leaders encouraged innovation and celebrated success, reinforcing a positive culture that was valued. For example, staff teambuilding days and fun competitions were standard practice. Several staff told us this had a positive impact. Comments included: “It makes me feel good, knowing I am valued and that I will be listened to”.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Managers had level 5 qualifications in health and social care. This meant managers had the capability to confidently lead the service. They had an open and honest approach to our findings and feedback and were committed to making immediate changes. This included developing capacity documents and ensuring people had risk assessments which covered all possible risks.

Leaders had systems in place to mainly support safe and effective oversight of the service. However during the inspection shortfalls in risk assessments, and care plan information were identified. The provider took immediate action to update these records.

Recruitment records showed managers had been appointed in line with Schedule 3 requirements, including full employment histories, references and Disclosure and Barring Service (DBS) checks. Leaders received regular supervision and had access to ongoing training to maintain their skills, including updates in safeguarding, governance and leadership development. The provider had policies in place covering supervision, training and workforce development, and managers’ training records showed they were up to date with mandatory learning. The registered manager status was current, and there had been no concerns about turnover or gaps in management oversight

Feedback from people and staff showed leaders were inclusive, empowering and compassionate. Staff were happy in their job. Comments included “[Registered manager] is fabulous as a manager” and “[Registered manager] is doing a great job and is supported by the wonderful ladies in the office”. When asked what impact this had on people, feedback included “It means me feel like not just my carer knows about my needs, but that I am being looked after by the office as well”.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Leaders promoted equity, diversity and human rights and ensured these principles were reflected in policies and in practice. The registered office had speaking up posters and information on how to complain, including how to raise concerns openly.

Staff told us they felt empowered to challenge poor practice and are ideas for improvement, and they were confident their voices were heard. One staff member told us “Quite a few of us reported to the manager that a few ways we did things were not working. They changed it, we were listened to”. This openness created a strong sense of trust and accountability across all areas of the service.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they were treated with dignity and respect and that when they did experience discrimination from people, colleagues were supportive. Comments included: “leaders put in place a range of supportive measures which included choice based on what I wanted as an outcome”, “Cera is equal for all” and “I can raise and discuss anything with [ manager].”

Leaders told us equality was a central part of their values. We triangulated this with evidence of equality questionnaires for staff and equality and diversity training which managers ensured staff completed. The provider had a statement on their website which referenced their pledge to ensure the gender pay gap was equal. This meant the provider was publicly committed to promoting fairness and equality within their workforce, and staff could feel confident that the organisation aimed to reduce inequalities and create an environment where everyone was treated fairly and with respect.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider did not consistently ensure that care visits were delivered on time, which impacted the reliability and continuity of care. At the time of our assessment, the service had not met their target of 70% rate of on-time visits. The provider’s auditing system did not provide further information to consider how timing of people’s visits could be improved. This meant that governance systems did not identify trends which could have improved service delivery. This shortfall posed a risk to people’s safety and well-being, particularly for those requiring time-sensitive support such as medicines administration or assistance with mobility.People told us that delays affected their daily routines and independence. Comments included “Sometimes I have to wait a long time, which makes me anxious” and “I rely on carers to help me get out of bed, and when they’re late, it’s really hard.”The provider acknowledged these concerns and had developed an improvement plan to address scheduling inefficiencies. However, at the time of inspection, this plan had not yet resulted in sustained improvement.This meant the frequency of late visits was still a concern as the provider was not meeting their key performance indicator. While staff were recruited safely and had the necessary training, the scheduling system and workforce planning did not always guarantee timely delivery of care.

Governance systems did not always identify that people’s care plans did not contain up to date information. For example several people’s care plans stated that they lacked capacity but in other care planning documents the same people were listed as having capacity.

Further, auditing systems had not identified people lacked personalised risk assessments. For example, one person did not have a diabetes risk assessment and another person did not have a risk assessment for allergies. We spoke to the provider who took immediate action to ensure risk assessments were drafted.

Several staff we spoke to told us they had not received a supervision meeting. Leaders did not have a supervision tracker in place. If they had, staff performance and wellbeing could have been monitored more effectively, emerging risks identified sooner, and the provider would have had clearer assurance that safe, consistent and accountable practice was being delivered.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

This included a situation where a person had recently been admitted to hospital. At the point of discharge from hospital, the provider ensured they had open communication channels with the occupational therapy team and GP service. Managers had used their experience to ensure that people were returning from hospital at off-peak times. This was to confirm if further hospital intervention was needed, there would not be a delay in ensuring people received the right medical support.

The provider told us they worked with a range of other professionals to help make sure people received continuity in their care. The provider had a tracker to document contact with the Local Authority. This ensured requests for support from the local authority were well documented.

The provider understood the importance of accessing the community and supported people to find events and gatherings that were of interest to them. For example, 7 out of 11 people told us the provider supported them to look for new activities and attend current interests outside of their home environment. This meant people maintained a social life and the risk of social isolation was reduced. People told us this impacted positively on their well-being. Comments included “I cannot leave the house on my own. When my carer takes me out, it is great as I am empowered to leave my house”.

The provider focused on continuous learning, innovation and improvement across the organisation. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and people’s individual needs so that they could deliver bespoke support to staff.

We saw the provider was open to learning and willing to adapt their approach to improve people’s experiences. For example, when an automated wellbeing‑check system was introduced, staff told us people did not like receiving recorded messages. When we spoke to people, they confirmed they felt it was not useful. In response, leaders quickly replaced this with personal calls from office staff, which people said felt more meaningful and helped them feel listened to and valued. Managers confirmed they actively seek feedback and use this to review systems, refine processes and implement changes that strengthen relationships and enhance people’s day‑to‑day experience of the service. This demonstrated a positive culture of reflection, improvement and innovation, where learning directly shaped better outcomes for people.

Further the registered manager who was relatively new in post was open to our feedback, and had implemented systems and process to better support people’s care and support since becoming the registered manager. For example, during the inspection, they took immediate action to update risk assessments and care plan information when shortfalls were identified, including adding missing allergy and diabetes risk assessments and producing clearer capacity documents for staff to follow. The registered manager informed us they would develop a new improvement plan based on the findings from our inspection.