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.

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

This meant people were safe and protected from avoidable harm.

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

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety, and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff understood the importance of reporting incidents and learning from them, and leaders supported team reflection and improvement. One member of staff told us, “After an incident whilst on shift, we always debrief. In the debrief, we go through the incident to see what was happening prior to the incident. What were the potential triggers, how do we best handle the situation if it happens again, what were the early warning signs, was anything missing in the Positive Behaviour Support Plan, how do we support the person better, and do the support plans or risk assessment need to be revised.”

We reviewed incident and accident records and saw evidence they were monitored and reviewed to identify learning. A detailed incident analysis report showed the service had begun to identify behaviour patterns, triggers and high‑risk periods for some people, and this learning had informed updates to behaviour support plans. Learning was shared with staff through bulletins and team communication.

This has improved since the last assessment, with clearer evidence of reflective learning and provider oversight.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

We saw evidence of joint working with health and social care professionals, including the use of hospital passports, shared information during transitions and staff shadowing existing providers. Leaders described how they assessed people before accepting new packages, including emergency admissions, and ensuring transition periods. Staff told us they worked closely with families to understand people’s needs and preferences, and information was shared through care plans and handovers.

This continued to improve, particularly in how transitions were planned and supported. However, leaders told us transitions were sometimes affected by external pressures, such as requests to accept packages without sufficient notice or transition periods, which increased risk and required careful management.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. When people receive care and treatment in their own homes, an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

Staff demonstrated knowledge of safeguarding processes and knew how to raise concerns. Safeguarding and whistleblowing policies were in place, and incidents were recorded. However, we found a gap in oversight of restrictive practices and deprivation of liberty processes. For one person, restrictions were recorded in care plans, but there was no corresponding record on the deprivation of liberty tracker. This increased the risk that people’s rights were not fully protected. A relative also raised concerns about restrictive practices being used without their involvement or advocacy support. We discussed this with the service, who told us they had spoken to the relative, but felt there may have been miscommunication, and would speak to the relative again.

Staff and relatives told us how people were supported to access their community including developing skills to protect the person from harassment and abuse.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments in relation to health and safety were present, and care plans were in place to guide staff on how to support people to manage those risks. Care plans were detailed with information for staff on how to avoid potential triggers in relation to known risks, for example, triggers which may cause a person to become distressed.

One relative told us how the service educated and supported a person to stay safe when going out by themselves. For example, they said, “(Person’s name) struggles to tell the time, so support workers help with this, and she uses an app.”

We received mixed feedback from relatives around being involved in care planning, the provider was in the process of creating new care plans and risk assessments, which were being shared with staff, relatives and people involved in the person’s care and treatment.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Most relatives told us people’s homes were clean, tidy and well-maintained.

We saw cleaning schedules and records for routine tasks, such as kitchens, bathrooms and waste management. Infection prevention and control policies and training were in place, and clinical waste was stored securely.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.