Marama Care HQ

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulations relating to safe care and treatment, consent to care and treatment and good governance.

This service scored 46 (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 ensure people’s care and treatment was effectively reviewed.

The service did not consistently follow its own policy. After incidents involving restrictive practices such as restraint and physical intervention, care and support records were not always reviewed or updated. As a result, records were sometimes inaccurate or out of date, limiting the service’s ability to prevent further incidents and placing people at risk of harm. A professional told us, “Recent care plan review for a client held historic information that was no longer relevant”.

This contributed to a breach of regulations relating to safe care and treatment and good governance.

The provider assessed people’s health, care, wellbeing, and communication needs before they began receiving support from the service.

A professional told us, “They (Marama Care HQ) promptly assessed the service user and requested extensive background information, attended meetings with the previous care provider, service user’s family, health professionals and social worker to ensure that they have a good understanding of the service user’s needs”.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. There was not always evidence that care and treatment were delivered in line with people’s assessed needs. For example, where a person had been identified as needing support with bathing, there was no clear record showing they had been offered support, received it, or declined it.

We received mixed feedback from relatives about staff supporting people to maintain contact with family members. One relative told us about planned contact that did not go ahead.

Another relative told us, “They (Staff) have a visual routine board which is updated daily on how many sleeps he has before he sees me. (Person’s name) understands the sleep count”. We observed this support in practice between the person and staff member.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

A professional told us about the positive impact the service had on a person and how the service had changed the person’s life, “The person who Marama support was in a high-risk situation with no accommodation or care. They provided a suitable and safe temporary solution and then worked alongside the MDT (Multi-Disciplinary Team) to find and get ready a long-term provision. During this very erratic and stressful time for the person they kept staff consistency high and followed the care plans, developing them where appropriate. Without Marama this individual was at risk of severe harm and (Person’s name) settled very quickly into their service and built trusting relationships that continue to this day”.

Staff told us the service work together like a family. Comments included, “Working in Marama had just been amazing and It is like having your own family”, and “The group of people working with Marama are like a family and the team work here is what I appreciate”.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

A person told us they did not always have a choice in the food provided, and staff sometimes cooked meals in their home they did not like. They gave an example of being a vegetarian and staff preparing meals that included meat.

A relative told us, “Frozen meals are given, vegetables and vitamins are needed”.

A professional told us, “Staff team are not offering choice to the clients. Eg meals/ visits. Staff teams are generally offering low nutritional meals regularly impacting on client’s health and wellbeing. Alongside this, there are frequent takeaways”.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Risks associated with diabetes were not always effectively managed. One person’s care and support plan required daily blood glucose monitoring and 30-minute wellbeing checks throughout the night. However, records showed inconsistencies in how staff monitored the person’s needs in line with their assessed support requirements. This placed them at risk of harm.

This contributed to the breach of regulation in relation to safe care and treatment.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People were subject to restrictions within their care and support, such as food portioning, constant supervision. Where mental capacity assessments were required under the Mental Capacity Act 2005, records showed these were not decision-specific and some mental capacity assessments were missing. The service had not completed mental capacity assessment or had consent from people to allow relatives to have access to their records. In cases where a person had been assessed as lacking capacity for a specific decision, a best interest decision had not been recorded. This did not evidence the provider had ensured the correct process had been followed to ensure that least restrictive practice options had been considered and all relevant parties were consulted during the decision making process.

We discussed these concerns with the registered manager, who took immediate action to begin addressing these concerns.

This contributed to the breach of regulation in relation to consent.