Archived: Marego Limited

Updated 3 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 6 and 7 April 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service.

This inspection was carried out by one inspector and a specialist advisor in nursing care. Before the inspection we looked at information we had about the service. Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.’

During the inspection, we spoke with the registered manager, deputy manager and the administration and quality manager. With permission we visited two people within their own homes during which we spoke with one person who uses the service and a relative of another person. We reviewed nine care plans and seven staff files and records related to the management of the service. We spoke with one professional involved with the service who attended the office during the inspection.

After the inspection we spoke with four relatives of people using the service and three care staff.

Updated 3 June 2016

This inspection took place on 6 and 7 April 2016. This was an announced inspection and the provider was given 48 hours’ notice. This was to ensure that someone would be available at the office to provide us with the necessary information.

This was the first inspection of the service since it registered with CQC in June 2014.

Marego Ltd is a domiciliary care agency based in North London which provides home based care for children and adults. At the time of the inspection, there were 21 people using the service, 18 of which were children. The service provides nursing and personal care, primarily to children with complex care needs. At the time of the inspection, the service was not providing nursing care.

The service has a registered manager. 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.

Risks were not adequately assessed for two adults who used the service. During the inspection we identified risks posed to one person which had not been identified by the provider. Detailed current risk assessments were in place for children using the service which were reviewed and updated regularly.

The service did not assess people’s capacity to make decisions about their care. The service did not have a Mental Capacity Act 2005 (MCA) policy in place and staff had not received training in MCA. The deputy manager told us that they have arranged for MCA training. Staff demonstrated an understanding of consulting with people before providing care.

Care plans were comprehensive, person centred and regularly reviewed. However care plans were not signed by either the person using the service or their relative.

The provider had a complaints procedure in place and relatives confirmed that they knew how to make a complaint. However, the provider did not log complaints or identify if learning or improvement should be undertaken following a complaint. The provider requested regular feedback from people and relatives.

The provider assessed quality of care by carrying out regular unannounced spot-checks on staff. These spot-checks were comprehensive and identified areas of concern such as medicines and recordkeeping and action was taken as a result.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

Regular spot checks undertaken by senior staff found that staff were not always recording the administration of medicines to people who use the service. The deputy manager confirmed that further medication training and spot checks would be undertaken for staff were there were concerns with management of medicines.

All staff had completed medicines training and care plans contained detailed instructions when administering medicines was part of the care package.

Procedures and policies relating to safeguarding children and adults from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and children and demonstrated an understanding on the types of abuse to look out for and how to raise safeguarding concerns.

The service maintained staffing levels to ensure that people’s needs were met. Relatives told us that the same staff provided care to their relative. Relatives also told us that staff attended on time, did not miss calls and if there were any problems, they were kept informed.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff had been trained in the use of specialist equipment prior to providing care for people. Staff had regular spot-checks and annual appraisals. Staff were safely recruited with necessary pre-employment checks carried out.

People who used the service and their relatives told us that they were happy with the care and support that they received. Staff knew the people they were supporting very well and carried out their duties showing dignity and respect at all times. During the inspection we saw caring interactions between staff and people who use the service.

At this inspection we identified breaches of Regulations 11 and 12. These breaches related to risk assessments and failure to comply with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.