Archived: Azure Charitable Enterprises - Washington

People’s experience of using this service and what we found

People were no longer at risk from unsafe care and treatment. Improvements had been made in relation to the Infection Prevention Control issues identified at our previous inspection, which led to enforcement action.

We were assured that the provider was monitoring the use of PPE for effectiveness and people’s safely.

Staff had received safeguarding training and were clear on how and when to raise their concerns. Where appropriate, actions were taken to keep people safe.

Records provided guidance to ensure people received safe, person-centred care and support from all staff members. Systems were in place for people to receive their medicines in a safe way.

People and relatives were complimentary about the care provided by staff. They trusted the staff who supported them. They said staff were kind, caring and supportive of people and their families. One relative said, "The staff are lovely and they employ good staff."

There was a cheerful atmosphere at the service. Staff spoke very positively about working at the home and the people they cared for. Staff said the manager was very approachable and they were supported in their role.

A quality assurance system was in place to assess the standards of care in the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Systems were in place to ensure the right culture was being promoted that people’s human rights were respected and their opinions were listened to and valued. People were supported to make choices and achieve their aspirations. Staff adopted the ethos to provide person-centred care that enabled individuals to develop skills and behaviours to live more independent lives. A relative told us, "[Name] has learned a lot since they have been there – staff have taught [Name] how to get ready, they pick their own clothes and food choices."

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 25 March 2021). 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 carried out an announced focused inspection of this service on 21 January 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve to ensure people received safe care and treatment.

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 Safe 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 Azure Charitable Enterprises-Washington on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

Azure Charitable Enterprise provides care, support and accommodation for up to 12 people. There were 10 people living at the home at the time of our inspection. Accommodation is provided from two separate houses which are adjoined by a garden area.

People’s experience of using this service and what we found

The provider did not have a robust system in place to monitor the infection and prevention control procedures within the service. This meant people were not always protected from the risk of infection in relation to the COVID-19 pandemic.

We have made a recommendation regarding IPC governance issues within the service.

Staff did not always follow government guidance in relation to the use and disposal of used PPE. Unused PPE was stored inappropriately which posed a risk of cross contamination. There was a lack of evidence to support an effective cleaning regime was in place within the service.

People's medicines were managed safely. Premises safety checks were completed on a regular basis. Staffing levels were at an appropriate level to ensure people received safe care. Recruitment processes were safe.

The registered manager and team managers completed a range of quality audits within the service. Any identified issues were followed up with appropriate actions. The service worked with various external professionals to ensure people received appropriate care. Staff felt supported by the registered manager and team managers. Relatives had no concerns about the care people received and they felt involved in people’s care.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted, right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

• Staff supported people to be as independent as possible across various aspects of their lives. For example, one person had expressed a wish to decorate their own bedroom with the assistance from staff. Staff had supported this person to achieve this goal.

Right care:

• The service provided an environment which allowed people to live their lives in a way which supported their dignity, privacy and human rights. Each person’s needs had been assessed and adjustments had been made to support improved outcomes for people.

Right culture:

• The registered manager and staff team worked very hard to ensure people’s happiness and well-being were pivotal to the care provided. Feedback from relatives was very positive in relation to the registered manager and the approach of staff. The service had adopted a creative approach during the COVID-19 pandemic with regards to activities within the service. This included the creation of an in-house shop and café which people made use of during the lockdown period.

The service had been through a difficult period during COVID-19. The level of commitment demonstrated by the registered manager and all staff members has been acknowledged. Those issues identified as part of the inspection have been shared with the registered manager and they have taken action to address the shortfalls identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 11 March 2020).

Why we inspected

We undertook this targeted inspection to review the infection and prevention control procedures (IPC) within the service and this was following a COVID-19 outbreak.

Due to the level of concerns identified regarding IPC issues, a decision was taken to widen the scope of the inspection. This meant the inspection became a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led key sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Since the inspection, the provider has submitted an action plan to us. This sets out the steps they have taken to address the issues identified during the inspection regarding IPC issues.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified one breach of the regulations relating to safe care and treatment. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Azure Charitable Enterprises – Washington, is a care home providing personal and nursing care to 10 people at the time of the inspection. The service can accommodate 12 people across two separately built houses which are connected via an adjoining communal garden area. Each 'house' has its own facilities

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found.

People and their relatives told us people were safe living at the home and they were protected from abuse. Assessments had been completed and reviewed to make sure people and the environment were safe. People’s medicines were handled safely. New staff were recruited safely, and enough staff were employed to support people. The homes were clean, tidy and staff had access to adequate amounts of protective equipment.

People’s needs were fully assessed before they received their package of care. People received care from staff who were skilled and experienced to care for people.

Staff received regular supervisions sessions to support them in their role. People were supported to eat and drink enough to maintain a healthy lifestyle. Where necessary staff referred people to their GP, and other medical professionals to make sure people were supported to remain well. People had access to various communal areas in the homes as well as a large garden area.

Staff cared for people with great care and respect. Staff knew the people they cared for very well. One relative told us, “The care [person’s name] gets is brilliant! I can’t fault them, they look after [person’s name] so well."

Families (and people where able), told us they were involved in the decisions made about the care they received. Staff provided care which was centred around people’s individual needs. Care plans were reviewed on a regular basis and where necessary changes to people’s care was made. People were supported to maintain both family and personal friendships. The provider had a complaints policy in place and any complaints had been handled in line with their policy.

The registered manager and staff had a good understanding of their roles and responsibilities. Staff had a good working relationship with various external professionals who supported them to care for people well. People, their relatives and visiting professionals, told us the service was well-led and spoke well of the registered manager. Staff told us they enjoyed working at the home and they felt valued, supported and listened to in their role.

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 improvements (published 13 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Azure Charitable Enterprises – Washington has been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning and physical disabilities using the service can live as ordinary a life as any citizen.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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 and associated Regulations about how the service is run.

At our previous inspection in June 2016 the service was rated as good. At this inspection the service was rated requires improvement and we identified three breaches of regulation.

Maintenance and health and safety checks were carried to ensure that the premises remained safe. However, a review of the provider’s fire risk assessment showed that no fire risk assessment had been carried by a suitably qualified person since 2014. Medicines were not always managed safely, and we identified issues during the inspection regarding the recording of peoples’ ‘as and when required’ medicines.

These issues demonstrated a breach of Regulation 12, Safe Care and Treatment. The provider took immediate action to address the issues we raised during our inspection.

The provider did not operate effective systems to monitor the quality of the regulated activity being provided to people. A review of quality assurance documents showed that audits completed at provider level had not been completed for a number of months.

This was a breach of Regulation 17, Good Governance.

You can see the action that we have asked the provider to take at the back of the full version of this report.

During the inspection we also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notifications of other incidents. This was because the provider had failed to notify CQC of a number of safeguarding incidents which they are required to do so by law. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

People and their relatives told us that they were safe living at the home. Safeguarding and whistleblowing procedures were in place and staff we spoke with were confident in their knowledge to be able to identify and report any suspected abuse.

Risks to people were assessed as part of their admission to the service and regular reviews of risk assessments were also carried out. The provider had various environmental risk assessments in place which were reviewed on a regular basis. Both houses were clean, tidy and decorated to a good standard. Staff carried out regular cleaning of both houses. Infection control policies were in place and staff were able to confidently tell us how they would follow this policy.

Staffing levels were appropriate to meet the needs of people living in the service.

The provider had a recruitment process in place and this included pre-employment checks. This meant that only suitable people were employed to work within the service.

People’s care records held lots of detailed information including how staff should care for them in the way they wished to be cared. They also included people’s aspirational goals. This meant that staff knew how to care and support people in the way they wished to be cared for. 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.

Staff received regular training which provided them with the skills they required to care for people safely. People and relatives we spoke with, told us that staff treated people with great kindness and dignity at all times.

People enjoyed and were encouraged to have a healthy and varied diet. People were able to have a choice of meals from the daily menu. Personal dietary requirements were catered for along with any requests for items outside of the menu. People had regular access to healthcare appointments and were supported by staff to attend their GP, dentist and hospital appointments.

People’s care plans were reviewed on a regular basis to ensure that people were receiving care that was appropriate to their needs. A range of activities were available for people to engage in both inside and outside of the home. These activities also focussed on people increasing their life skills to promote people’s independence.

The provider had a complaints policy in place and this was available for people to access. Three complaints had been received since the last inspection and were logged and actioned in line with this policy.

Staff we spoke with told us they felt supported both by the registered manager and deputy manager. Feedback received from a healthcare professional had complimented the service and the managers for the level of care and support delivered.

Regular feedback was sought from people and their relatives. This was done via a yearly questionnaire and a review of the last survey results showed positive feedback.

The home had good working relationships with other healthcare organisations. This included regular engagement with various local authority teams, local GPs and local clinical commissioning groups.

Azure Charitable Enterprises - Washington provides accommodation and personal care for up to twelve people who have learning disabilities. At the time of the visit eleven people were living at the service. Azure Charitable Enterprises - Washington comprises of two separate houses each providing care for up to six people.

The service was last inspected in December 2013. We found they were meeting all the regulations we inspected.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff had completed safeguarding training and were confident in identifying and reporting safeguarding concerns.

The provider ensured all pre-employment checks were carried out before applicants started work. People were involved in the recruitment of new staff and the selection of their key worker.

People, relatives and staff told us there were enough staff to meet people’s needs. Our observations supported that opinion.

Risk assessments were specific to the person and identified the risk and the actions needed to be taken to keep the person safe.

People were supported to maintain good health and had access to healthcare professionals.

Staff received a range of training, including moving and handling, first aid and fire safety, person specific training such as epilepsy training was in place to ensure people’s needs were met.

Medicines records we viewed supported the safe administration of medicines. Medicines records were up to date and accurate

Staff had a good understanding of their responsibilities under the Mental Capacity Act (2005) (MCA).They were aware of the capacity of people they were supporting and described how decisions were made in people’s ‘best interests.’

Staff we spoke with were knowledgeable about the people they supported. They were aware of their preferences and interests, as well as their health and support needs.

The service had a warm happy atmosphere with people’s needs, wishes and interests the focal point to all activities.

People’s independence was encouraged and staff supported people to achieve their goals.

Care plans were comprehensive and included clear information for staff to make sure each person’s specific needs were met.

The provider had an effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support.

People were involved in planning their own care and staff supported people in an engaging way. We asked people using the service whether they were happy at the home, they told us 'Yes' and 'I love it'. A relative told us 'He is always smiling.'

The service had an effective recruitment and selection procedure in place and carried out relevant checks when recruiting staff. A relative told us 'They are nice staff.'

There were systems in place to regularly check the quality of the care and people were consulted about the care they received. The service had an effective complaints procedure in place.

One person confirmed that they liked living at the service and had chosen the colours within their bedroom.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.