This inspection took place on 23, 26 and 29 January 2018 and was announced. This inspection was the first comprehensive inspection of the service since it was registered with the Care Quality Commission (CQC) on 11 April 2017.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.