About the service: 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 this inspection, there were 68 people using the service.

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.

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 un