Cera - Wiltshire

Updated 24 August 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was undertaken by three inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses.

This service also provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection, as we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with 11 people who used the service and eight relatives about their experience of the care provided. We spoke with eleven members of staff including the registered manager, operations director, regional manager, and care workers.

We reviewed a range of records. This included 12 people’s care records and multiple medication records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at a further five people’s care records and medication records. We looked at a variety of records relating to the management of the service, including quality auditing, policies and procedures. We spoke with two professionals who have contact with the service and received written feedback from one other.

Updated 24 August 2021

About the service

Cera – Wiltshire is a large domiciliary care agency that provides personal care to people in their own homes.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. Personal care is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People’s medicines were not being safely managed. Audits had identified on-going errors, but more were identified at this inspection. Time specific medicines were not consistently given at the same time each day, and staff were giving one person their pain relief within the recommended time frame of four hours. This placed the person at risk of overdosing. Medicine administration records had not been accurately completed, and supporting documentation was not always available to ensure medicines were given as prescribed. Staff had received training in the safe administration of medicines, but not all had had their competency assessed.

Not all risks to people’s physical and mental health, had been identified and sufficiently addressed. This included one person’s risk of blood clots, and another person of very low mood, with the risk of suicide. Other risks associated with falling and the environment had been considered. Accidents and incidents had been appropriately documented and reported, with immediate actions taken where required.

Infection prevention and control measures were in place. This included staff training, large stocks of personal protective clothing (PPE) and a contingency plan in the event of high levels of staff contracting COVID-19. However, the staff testing programme was not mandatory, and staff were not expected to inform the registered manager if they had completed a test, or its outcome.

There were not always enough staff to ensure the reliability and efficiency of the service. This was particularly so at weekends or at times of staff sickness. Feedback from some people and staff, confirmed visits could often be late or not consistently at the same time each day. Staff recruitment was on-going and new staff were regularly starting employment at the service. Safe systems were in place to ensure those staff appointed, were safe to work with vulnerable people.

Systems were in place to help protect people from the risk of harm. Staff had received training in safeguarding and were aware of their responsibility to report any concerns. People felt safe with staff supporting them, and relatives had no concerns about safety.

People did not always receive a personalised service, which met their individual needs. Some timings of visits were inconsistent, and not always at a time to suit the person. Staff told us they had no, or sometimes very little travel time, which meant they were often late arriving to support a person. Some staff felt pressurised and found travelling between people’s visits stressful.

The content of people’s care plans was variable in detail and accuracy. One plan stated a person had a catheter but there was no information for staff about how to manage it. Another plan gave discrepancy, regarding the application of a person’s pain patch. Much of the information staff had recorded within the communication logs, was task orientated rather than person centred. A new electronic care planning system was being introduced to help these areas.

Management told us promoting social activity to avoid social isolation was an important part of the agency’s vision. However, not all staff took the opportunity to spend time with people, once all required tasks had been completed. Records showed some staff had left earlier, rather than use the time to reduce social isolation. The registered manager confirmed promoting social activity would be further addressed, once the restrictions of the pandemic eased.

People and their relatives were given a copy of the complaints procedure when they first started using the service. They knew how to raise a concern or a formal complaint if needed. Improvements had been made to the complaints process following a complaint which had been made before our inspection and not been handled well. This included a department within the organisation, reviewing any documentation before it was sent to the complainant.

Auditing systems were in place to assess and monitor the service. However, not all were effective as the shortfalls identified at this inspection had not been identified. Investigations into the root cause of medicine errors, or measures taken to minimise them, had not been adequate to ensure improvement.