This inspection took place on 15 August 2017. The provider was given advance notice because the location provides a domiciliary care service and we needed to ensure that the registered manager would be present to provide the information and documents necessary for the inspection.

During the last inspection on 6 and 7 April 2016 we found the service was in breach of two legal requirements and regulations associated with the Health and Social Care Act 2008. These breaches related to compliance with the Mental Capacity Act (2005) and assessing risk.

Marego Limited 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 22 people using the service, 19 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 staff.

The service had 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.

At this inspection, we found detailed and up-to-date risk assessments were in place for people using the service. These explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

Significant improvements had been made to ensure that consent to care was obtained from the appropriate person. The service had implemented a policy and training around mental capacity and obtaining consent.

We received positive feedback from relatives and health professionals regarding overall service provision, the caring nature of staff and the high standards of care delivered.

We found that care plans were person centred and reflected what was important to the person which enabled staff to deliver person centred care in line with people's preferences. Care planning was carried out in partnership with the person’s family.

We found that staff training, supervisions and appraisals were monitored and updated regularly. There was a comprehensive and on-going training programme. Staff had been trained in the use of specialist equipment prior to providing care for people. Staff were safely recruited with necessary pre-employment checks carried out.

Medicines were managed safely and effectively and there were regular medication audits in place. Staff had completed medicines training and had their competency to administer medicines assessed.

The service regularly requested feedback from people who used the service, to improve the quality of care people received.

People were encouraged and supported to access the community and engage in activities of their choice.

The management team enabled an open culture that encouraged staff to discuss issues and areas for improvement.

The provider had a quality monitoring system to ensure standards of service were maintained and improved.