We carried out a review of the data available to us about Mariama Care Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Mariama Care Ltd, you can give feedback on this service.
Mariama Care Ltd trading as Kangaroo Care is a domiciliary care service. It provides personal care to people living in their own homes and flats in the community. The service supports older people with a range of physical and sensory disabilities as well as people living with dementia. At the time of this inspection there were 55 people using the service.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
At the last inspection in February 2019, we identified several issues and concerns which meant that people may not have always been received safe and good quality care. During this inspection we found that the registered manager had implemented robust systems and processes which had led to significant improvements to the quality of care people received.
People and relatives told us that they felt safe and re-assured with the care and support delivered and spoke positively about the way in which the service was managed.
Risks identified with people’s health, care and support needs had been comprehensively assessed with clear guidance on how to manage and minimise risk to keep people safe and free from harm.
People received their medicines safely and as prescribed. Policies and systems in place supported this.
Recruitment checks were complete and adequately assessed staff suitability to work with vulnerable adults. People and relatives told us that they were supported by regular care staff who generally arrived on time.
Care staff had access to the required personal protective equipment (PPE), information and guidance to prevent and control the spread of infection.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were supported with their nutrition and hydration where this was an assessed need. Where required the service supported people to access health and social care professionals to support their well-being.
Care staff spoke positively about the registered manager and management team and stated that they received the required training and support to carry out their role.
The overall management oversight of the service had improved since the last inspection. The registered manager had implemented audits and checks to monitor the quality of care and ensure where issues were identified these were addressed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 17 April 2019) and there were breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We had carried out an announced comprehensive inspection of this service on 19 and 20 February 2019. Breaches of legal requirements were found which included safe care and treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mariama Care Ltd on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service: People and their relatives generally told us that they were satisfied with the care and support that they received from allocated care staff from Mariama Care Ltd. They told us that they felt safe with the care staff supporting them and that care staff were kind and caring. Negative comments made were around the lack of regular staff and not knowing who was going to attend the care call and at what time.
Medicines management and administration processes were not always safe. Records seen did not give assurance that people received their medicines safely and as prescribed.
Individualised risks associated with people’s health and medical care needs were not always identified and assessed to give guidance to care staff on how to minimise those risks to keep people safe.
Care plans did not detail or reflect the care that people were actually receiving when compared with daily records completed by care staff. This was especially significant where people had known risks associated with their care needs.
Management oversight process in place to monitor the quality of care people received were ineffective and did not identify any of the concerns we found as part of this inspection.
Although people’s lack of capacity had been recorded within their care plan, no further information was available about any specific decisions that had been made in their best interest.
Care staff were aware of the different types of abuse that people could be subjected to and knew the steps they would take to report their concerns.
People and their relatives knew who to speak with about any concerns or issues they had to raise. Most people and their relatives were confident that their concerns would be addressed satisfactorily.
Care staff were appropriately supported through regular training, supervisions and annual appraisals.
Staff recruitment processes followed ensured that only those staff assessed as safe to work with vulnerable people were recruited.
More information is in the detailed findings below.
We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and the governance of the service. We have also made a recommendation around the MCA 2005 and its implementation. Details of action we have asked the provider to take can be found at the end of this report.
Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published March 2018). This service has been rated as Requires Improvement for the second time.
Why we inspected: This was a planned inspection based on the rating at the last inspection. At the last inspection we found areas of concern around staff recruitment, poor timekeeping of care calls, care plans were not always responsive to people’s needs, information contained within care plans was sometimes inconsistent and ineffective management oversight processes. At this inspection we found that improvements had not been made to these areas and we continued to find further areas of concern that required improvement.
Follow up: We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
Mariama Care Ltd trading as Kangaroo Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and people with a range of physical and sensory disabilities as well as people living with dementia. At the time of the inspection the service was providing care and support to 79 people.
This is the first time the service has been rated Requires Improvement.
Not everyone using Mariama Care Ltd receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
A registered manager was in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Risk assessments identified people’s individual risks and provided clear guidance to staff on how the risks were to be managed in order to keep people safe and free from harm. We did find that for two people, specific risks that had been identified had not been assessed, however this was rectified immediately and appropriate risk assessments were put in place.
Since the registration of the service, the Care Quality Commission (CQC) had received a high number of safeguarding concerns which related to poor care, late visits, missed visits and issues with medicines administration. We discussed these concerns with the registered manager as part of the inspection process. The registered manager was able to give detailed information about each concern with actions that the service had taken to make the necessary improvements.
Although the service confirmed that sufficient staff were available to provide care and support, people and relatives feedback was that care staff were arriving late for their visits or were not staying the full allocated time. The service was working towards implementing a number of systems to address these concerns so that people’s experiences of care and support would improve.
The service had safe recruitment processes in place to ensure that staff recruited and employed were assessed as being safe to work with vulnerable people. We highlighted to the registered manager that they must always ensure that satisfactory references, evidencing staff members conduct in previous employment was obtained as well as any gaps in employment were explored and reasons for gaps clearly documented.
Safe medicines management and administration processes were in place to ensure that people received their medicines as prescribed. However, the registered manager needed to ensure that medicine audits were completed robustly to ensure that all discrepancies were identified and addressed.
Care plans contained pre-service commencement assessments confirming that the service always carried out an assessment of need prior to providing a service. People’s choices, wishes, likes and dislikes were recorded as part of this assessment to ensure that care and support was planned and delivered to achieve the person’s desired outcome.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
Care plans were detailed, person centred and were reviewed on a regular basis. People had consented to their care and support and where people were unable to consent, documents confirmed that relatives had been involved in the decision making process where appropriate.
Care staff received appropriate and relevant training and support to enable them to deliver their role effectively.
The service ensured that all accidents and incidents were reported and recorded with details of the incident and the actions taken as a result in order for the service to learn and improve.
People, where required, were supported to access a variety of health care services to ensure that they received appropriate care and support. People were also supported with their nutritional and hydration requirements where this had been identified as an assessed need.
Most people and relatives were happy with the care staff that supported them and confirmed that their allocated care staff were kind and caring and were respectful of their privacy and dignity.
The service had processes in place which dealt with complaints and concerns. A log of each complaint was in place which detailed the nature of the complaint, how it was dealt with and the outcome for the person. The service listened and responded to people’s concerns and complaints, and used this to improve the quality of care. The service learnt lessons and made improvements when things went wrong.
The registered manager had a number of checks and audits in place to oversee the quality of care and support that people received. However, on occasions these checks were not always robust enough and did not always identify some minor issues that we identified. In addition details of actions taken to address concerns were not always recorded.
Whilst we found that the service was not in breach of any of the regulations defined by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we found that there were a number of areas where the provider needed to ensure improvements were made and sustained. These areas of concern have been reported on within each of the key questions.