Azure Charitable Enterprises – Washington is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation and personal care for up to twelve people who have learning disabilities. The service was made up to two separate houses, each able to accommodate six people. At the time of inspection 10 people were living at the service.

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.

During the inspection we also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulation 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. We are dealing with this issue outside of the inspection process.

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

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

This inspection took place on 13 June 2016 and was announced. The inspection was announced to ensure people who used the service would be present.

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.

Some of the people using the service had complex needs which meant they were unable to tell us their views. Because of this we used a number of different methods to help us understand their experiences.

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.

During our inspection we found that interactions between staff and the people who used the service was polite and appropriate. People were engaged in activities during our inspection and told us they liked the staff.

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.

The service is provided from two houses which are separated by their rear gardens. At the time of our visit nine people were living in the home.

We met with people from both houses, and one visitor. We did not meet any visiting professionals during our visit.

Few people were able to converse with us due to their speech and language impairment, but those who could were happy with their care and surroundings. They said, “I like it here, they are nice people and they help me”.

A visitor we spoke with said, “It’s tremendous, I couldn’t praise staff highly enough”.