Cera Wiltshire is a homecare agency is registered to provide support to people living in their own homes. The service supports people living with dementia, people with learning disabilities, physical disabilities and sensory impairments. At the time of our assessment there were 143 people receiving a regulated service. We visited the service on 17 and 18 December 2025. The inspection was carried out because of the length of time since the last assessment. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture’ is the guidance The Care Quality Commission follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. Providers must also ensure they have an understanding of “stopping over medicating of people with a learning disability and autistic people” (STOMP). The assessment was a fully comprehensive inspection, which looked at all key areas. During the last inspection we found the provider was in breach of the legal regulations in relation to medicines administration, good governance and ensuring fit and proper staff employed. During this inspection we found improvements in all these areas had been made and the service was no longer in breach of regulation. We identified some shortfalls with the provider’s governance systems. However, the provider had an awareness of these shortfalls and had developed an improvement plan. Care being delivered on time was still a concern, and the service was only meeting a 74% rate of on time visits. This was picked up in monthly audits but sufficient progress had not been made by the provider to meet their own key performance indicators (KPIs). Staff had been recruited safely with all pre-employment checks completed prior to them starting. Staff training was current, in line with national standards and all staff had the care certificate qualification as a minimum. However, we identified some shortfalls in risk management where people’s risks had not been documented. Staff told us leaders and managers supported them well. The provider had a focus on staff well-being, organising team meetings and informal drop-in sessions at the registered office. All staff had completed safeguarding training and expressed confidence that any concerns raised would be addressed appropriately by leaders. However, there were some shortfalls with care planning documents which lacked documentation relating to people’s capacity. Most care plans contained personal preferences regarding how people liked their care to be delivered. Staff protected people’s privacy and dignity. They treated people as individuals and supported their preferences. People had choice in their care and were encouraged to maintain relationships with family and friends. People were not always involved in decisions about their safety, and care plans did not always contain detailed, dynamic information tailored to individual needs. This shortfall meant people were not always empowered to maintain independence and control over their lives. Environmental safety was embedded into everyday practice. Staff were trained to identify hazards and escalate concerns promptly, supported by regular competency checks and scenario-based learning. Proactive referrals ensured people’s homes were adapted to meet changing needs. This enabled people to feel safe and respected in their own environment.
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Cera - Wiltshire was rated Requires Improvement following breaches of Regulations 12 (safe care and treatment), 17 (good governance) and 18 (staffing), driven by unsafe medicines management, late or inconsistent visits and ineffective audits. People felt safe with staff and recruitment was robust, but care plans lacked detail and governance failed to identify or address recurring shortfalls.
Concerns (12)
criticalMedication management: “one person had regularly been given paracetamol more often than the recommended four hourly timeframe. This meant they were being overdosed and at risk of significant harm.”
criticalMedication management: “Time critical medicines were not always being given consistently as recommended. For example, one person who received a medicine associated with Parkinson's disease was given it on different days at 13.45, 11.50, 12.10 and 13.15.”
criticalMissed or late visits: “Timings of visits were inconsistent, and not always at a time to suit the person... one person who needed their teatime visit at 18.00, due to dietary needs, but some of their visits were documented as 19.00, 18.55, 20.15 and 19.20.”
criticalStaffing levels: “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.”
criticalGovernance: “the auditing systems in place were not sufficiently robust in identifying and addressing shortfalls in the service. This was a breach of Regulation 17, Good governance”
moderateRecord keeping: “The medicine administration records (MAR) were not always clear and did not always detail all medicines, and their prescribing instructions. The MARs had not always been fully completed by staff”
moderateStaff competency: “not all staff had completed an assessment to demonstrate their competency when managing people's medicines.”
moderateCare planning: “The content of people's care plans was variable in detail and accuracy. For example, one care plan stated a person had a catheter, but there was nothing about the management of the catheter”
moderatePerson-centred care: “Much of the information about people's support, which staff documented in the communication logs, was task orientated and not person-centred.”
moderateIncident learning: “There had been regular errors with people's medicines and as a result, the staff involved had received additional training. However, there was no investigation as to why the errors were occurring.”
moderateInfection control: “the testing was not mandatory, and staff were not required to inform the registered manager of the test's completion or the results.”
minorComplaints handling: “Improvements had been made to the complaints process following a complaint which had been made before our inspection and not been handled well.”
Strengths
· Safe recruitment systems with appropriate checks for new staff
· Staff received safeguarding training and people reported feeling safe
· Large stock of PPE with collection points and staff training on correct use
· Contingency plan in place for high levels of COVID-19 staff absence
· 96.6% of staff team had completed refresher training
Quality-Statement breakdown (14)
safe: Using medicines safelyNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
Mears Help to Live at Home Wiltshire, a large domiciliary agency supporting approximately 900 people across Wiltshire, was rated Requires Improvement across all five key questions at its first inspection in October–November 2017. Key failures included unsafe medicines management, insufficient staffing levels, inconsistent and late visits without adequate communication, gaps in condition-specific staff training, and governance systems that had not identified or resolved service-user dissatisfaction.
Concerns (13)
criticalMedication management: “The records did not always clearly show the person's prescribed medicines and instructions for their use. One record showed a list of the person's medicines but there was no detail about the dosage or how often they were to be taken.”
criticalMedication management: “There were gaps in recording on some of the MARs. This meant there was no evidence to show if people had been administered their medicines, as prescribed.”
criticalStaffing levels: “One relative told us their family member required two staff to assist them at each visit but there were occasions when only one member of staff attended.”
criticalConsent / capacity: “One person's plan stated they were to be given their medicine on a spoon with meals or yogurt. It was not clear whether this was to covertly administer the medicines or to aid swallowing with the person's consent.”
moderateMissed or late visits: “I feel it is an utter shambles to be honest. This morning they came at 11:45am but we asked for a carer between 7:00am - 7:30am.”
moderateMissed or late visits: “The majority of people told us the office did not tell them if staff were going to be late.”
moderateStaff training: “Records did not show staff had received training around people's complex medical conditions. This included Multiple Sclerosis and PCP (Progressive Supranuclear Palsy).”
moderateStaff competency: “If the regular carer is on holiday, they send in staff that haven't even used the hoist. They can't even operate it.”
moderateRecord keeping: “A person had fallen and sustained injuries. Staff had not documented how the person presented, their pain or any adjustments they needed with their care.”
moderatePerson-centred care: “People's wishes in relation to who supported them were not always respected. Some people cancelled their visits as the allocated staff member was of a different gender, to what they wanted.”
moderateGovernance: “The issues leading to people's dissatisfaction, as raised during the inspection, had not been identified or further explored. This did not ensure improvements were made.”
minorRecord keeping: “Much of the information within the log was task orientated and did not demonstrate areas such as how the person presented.”
minorComplaints handling: “Some entries on the daily handover forms, which could be seen as complaints or concerns, were not documented separately on the complaint's log. This did not enable the information to be captured and potential trends to be identified.”
Strengths
· Safe recruitment procedures were in place, including DBS checks, formal interviews, literacy tests and exploration of employment history gaps.
· Staff demonstrated awareness of safeguarding responsibilities and any concerns were appropriately investigated with lessons learnt.
· Risks associated with mobility, nutrition, environment and fire were identified and actions taken to promote safety.
· People praised the caring nature of regular staff, with many reporting excellent relationships and staff promoting dignity, privacy and independence.
· Clear support plans were in place, co-produced with people, and health and social care professionals were involved in their development and review.
Quality-Statement breakdown (23)
safe: Medicines managementRequires improvement
safe: Staffing levels and deploymentRequires improvement
safe: Safe recruitmentGood
safe: Risk assessment and managementGood
safe: SafeguardingGood
safe: Missed and late visits monitoringRequires improvement
effective: Staff training and inductionRequires improvement
effective: Staff supervision and appraisalRequires improvement
Cera - Wiltshire improved from Requires Improvement to Good across Safe, Responsive and Well-Led key questions, having resolved prior breaches of Regulations 12 and 17 through strengthened medicines management, personalised care planning, and more robust governance and auditing. Effective and Caring were not inspected and carried forward Good ratings from the previous comprehensive inspection.
Concerns (4)
moderateMedication management: “At our last inspection, medicines were not managed safely. At this inspection improvements had been made to the administration, recording and auditing of medicines.”
moderateCare planning: “At our last inspection in June 2019 care plans did not reflect people's preferences of times of visits. People did not always receive visits at the times they were expecting.”
moderateGovernance: “Audits were not effective as shortfalls in the service were not always being identified or addressed. Recommendations made at the previous inspection had not been fully addressed.”
minorMissed or late visits: “Sometimes they don't get here till 11:30...they can be a bit late but nothing excessive, though they don't always stay the full time.”
Strengths
· People consistently reported feeling safe with staff, with very positive feedback about staff conduct and care quality.
· Medicines administration, recording and auditing had significantly improved since the previous inspection, resolving the prior Regulation 12 breach.
· Care and support plans were redesigned to be detailed, personalised and incorporate individual risk assessments with condition-specific guidance for staff.
· Robust audit schedule introduced covering all areas of care, with actions tracked and followed up effectively.
· Strong end of life care provision with specialist training for staff and very positive feedback from relatives.
Mears Help to Live at Home Wiltshire received an overall rating of Requires Improvement for the second consecutive inspection, with breaches of Regulations 12 and 17 identified relating to unsafe medicines management, inadequate risk assessment, inconsistent visit timings, and ineffective governance audits. Strengths were noted in the caring domain, where staff were highly praised by people and relatives, and where dignity, consent, and involvement in care planning were well promoted.
Concerns (9)
criticalMedication management: “medicine administration records stated the medicines were given at 11.05 and again at 11.50. Assessments to identify any risks with medicines, had not been completed.”
criticalGovernance: “Audits were not effective as shortfalls were not always being identified or addressed. Recommendations made at the last inspection had not been fully addressed.”
moderateCare planning: “information was not always transferred to people's support plans. This included aspects such as self-harm, and the restrictions associated with arthritis.”
moderateMissed or late visits: “staff arrived to support one person at varying times between 07.07 and 10.58. Their preferred time was between 09.00 and 09.45.”
moderateRecord keeping: “visits were recorded as cancelled rather than missed. This did not give an accurate account of the missed calls, which had occurred.”
moderateStaff training: “staff provided personal care to some people with mental health conditions but had not received specific training in such areas.”
moderatePerson-centred care: “one person's support plan stated they liked to 'get up late morning' but some of their visits were around 08.30.”
minorComplaints handling: “some people said they were not sure how to make a formal complaint. Most were not upheld with the outcome being 'customer perception.'”
minorEnd-of-life care: “One support plan did not clearly show the care the person needed, as their health deteriorated.”
Strengths
· People were particularly complimentary about regular staff, with comments such as 'Their commitment is unquestionable' and 'They are absolutely excellent. I love them to bits.'
· Safe recruitment practices were followed and new staff completed a nationally recognised induction programme before working independently.
· People felt safe and staff were aware of their responsibilities to identify and report safeguarding concerns.
· Staff had excellent infection control and hygiene standards as reported by people using the service.
· Improvements made to consistency of staffing, with most people allocated a small regular team.
Quality-Statement breakdown (22)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
Not rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
effective: Consent and mental capacity
Requires improvement
effective: Nutrition and hydration supportGood
effective: Working with health and social care professionalsGood
caring: Staff attitude and relationshipsGood
caring: Dignity, privacy and independenceGood
caring: Consistency of care and person-centred preferencesRequires improvement
responsive: Timing and consistency of visitsRequires improvement
responsive: Support planning and person-centred careGood
responsive: Communication with people about visit changesRequires improvement
well-led: Quality assurance and governanceRequires improvement
well-led: Leadership and management oversightRequires improvement
well-led: Staff engagement and cultureGood
well-led: Continuous improvement and learningGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies and healthcare servicesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support with opennessRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careRequires improvement