Marama Care HQ

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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was in breach of the legal regulation relating to safe care and treatment.

This service scored 56 (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 listened to concerns about safety and investigated. However, the service did not always have a proactive and positive culture of safety. For example, although monthly incident monitoring tools were in place, they failed to identify patterns or trends that could help prevent harm to people and staff.

Professionals told us the service shared incident information and welcomed ideas and challenges.

The provider worked with people and healthcare partners to support continuity of care, including during transitions between services. The registered manager gave us examples of how they are mindful of people’s personalities and needs when considering new people moving in, for example having sleepovers at the service. Before delivering care, they obtained relevant information from social workers, brokerage teams and other involved services to ensure safe and consistent support. However, the systems in place did not identify the concerns we found at this inspection. For example, care plan reviews were not always effective.

Most relatives told us people transitioning to Marama Care HQ had a good experience. A professional told us, “They (Marama Care HQ) completed a week of 24 hour shadowing period with the previous care provider. I received positive feedback from the previous provider regarding the professionalism and engagement of Marama Care staff”.

Staff knew how to report safeguarding issues and safeguarding processes were in place we found people’s rights linked to restrictions and the MCA were not always upheld. This is reported on in the consent to care and treatment quality statement.

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 and neglect.

The provider shared concerns promptly and appropriately with the local authority. Staff understood their responsibility to raise concerns and were familiar with the whistleblowing procedure. Staff told us they would report any abuse or concerns to the registered manager or safeguarding lead. One staff member told us, “They (Management team) are so open and transparent here, I asked the (Management team), are you sharing the safeguarding info with staff, they told me, of course how are staff going to learn otherwise”.

Relatives told us the service used restraint positively. A relative told us, “There have been no incidents, never have had to restrain him. (Person’s name) previous provider had to restrain them”.

The provider did not always work well with people to understand and manage risks. Staff did not always deliver care that met people’s needs safely. Where risks had been identified, the service did not always identify and take all reasonably practicable steps to reduce these risks. Care and support plans lacked clear guidance for staff, and daily records did not consistently show people had been supported in line with their assessed needs, placing them at risk of harm. Incidents were reported and reviewed, however people’s care records were not always updated following the incidents.

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

A professional told us, “Marama will update us at monthly MDT’s (Multi-Disciplinary Team) meetings, but will rarely divulge any information before that. Risk assessments have been raised within (Person’s name) and MDT noted that some risk assessments were not completed”.

The provider detected and controlled potential risks in people’s own homes. They made sure equipment, facilities and technology supported the delivery of safe care. The registered manager had recently reviewed a safeguarding concern, which led to lessons being learnt and additional risk assessments and checks being carried out on people’s vehicles.

A relative told us about an incident involving a broken window. We raised this with the provider, who had taken and continued to take steps to make the area safe and support the person to raise these concerns with the relevant people managing the property. Most relatives told us the service supported people to live in a safe environment. Comments included, “(Person’s name) home is clean and safe”, and “Front door is locked, front and back garden are safe”.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staffing levels and rotas confirmed the service had enough staff to meet people’s needs. Recruitment records reviewed during the inspection included Disclosure and Barring Service (DBS) checks and evidence of staff inductions, including completion of the Care Certificate.

Staff received regular supervision, which they confirmed. One staff member told us, “The management are really supportive and I have not seen a company like it and even the owner sat down with us in our induction”.

Staff told us they received training in PMVA (Prevention and Management of Violence and Aggression), trauma, learning disabilities, autism, communication, and person-centred care. The service’s training matrix confirmed this.

The provider assessed and managed infection risks but did not always detect or control the risk of it spreading. The registered manager had identified daily cleaning checks and tasks, but records did not consistently show these were completed. We raised this with the registered manager, who told us they were taking action to address this concern.

Training records confirmed staff had received COSHH (Control of Substances Hazardous to Health) and Infection Prevention and Control training.

Staff told us there was enough PPE (Personal Protective Equipment).

Relatives told us people’s homes were clean and tidy.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. The provider had PRN (as-needed) medication protocols and homely remedies guidance in place. Staff carried out weekly medication audits, and any concerns were discussed with the management team.

The registered manager told us they were experiencing issues with their pharmacy delivery team, resulting in delays in medication reaching people’s homes. They told us they were supporting people to change pharmacies.

One person told us they knew what medication they were being administered and knew what time these should be administered.

A relative told us, “Medication is given on time”, and others told us there had not been any concerns with people’s medication.