Marama Care HQ

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• 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.

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

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The provider was previously in breach of the legal regulations in respect of safe care and treatment, consent to care and good governance. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

This service scored 63 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Some records contained historic or inaccurate information, and changes in people’s presentation or risks were not always reflected promptly in written guidance for staff. The provider told us they were now introducing a new care planning format intended to be more person‑centred and to clearly show who was involved in developing plans. At the time of the assessment, this was not yet fully embedded, meaning staff were still relying on existing plans that did not always provide clear or current guidance.

Care records showed assessments and care plans were in place and generally described people’s needs.

One relative told us, “They (management team) didn’t mention the inspection or bring the report to our attention, but I went and read it anyway, which I found concerning. Since then, there seems to be more person-centred approach and care plans are much better.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider did not always plan and deliver care and treatment in line with current evidence‑based practice. Some care plans lacked clear clinical guidance, and records did not always demonstrate agreed care, such as oral hygiene support, was delivered as planned. This limited assurance that care and treatment were always safe, effective and based on best practice.

Staff used recognised tools and approaches, including body mapping, blood glucose monitoring, behaviour support planning and multidisciplinary input. We saw examples where health monitoring had improved since the last assessment, such as more regular overnight checks and diabetes monitoring for a person.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Relatives and records confirmed staff supported people to attend health appointments, worked with professionals and encouraged community access and meaningful activity. We saw evidence of medication reviews, dental appointments and involvement from multidisciplinary teams.

We received mixed feedback from relatives in relation to people not always being offered meaningful choice, particularly around shopping. However, a relative, when asked what they thought about food options provided, told us, “Very well thought out and planned well. Considerable time is taken to ensure my son receives a well balance healthy diet. They make time and put in effort to ensue he has meals that are home cooked and made by scratch.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

The provider had systems for incident reporting, audits and monthly reviews, and staff described learning from incidents through debrief and team discussions. We saw examples where learning had led to changes in practice, including adjustments to staffing and support approaches.

Since our last assessment, oversight of health and safety checks such as daily blood glucose monitoring and 30-minute wellbeing checks throughout the night had improved.

The provider did not always ensure people’s rights to consent were fully respected in practice.

Relatives told us they were not always involved in decisions about restrictive practices, and one person’s care plans did not clearly document restraint or the legal basis for restrictions.

Improvements had been made since our last assessment, and we saw records of mental capacity assessments. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff demonstrated a good understanding of mental capacity and best‑interest decision‑making, and capacity assessments were within care records.