The inspection took place on 11 December 2018 and was unannounced. The inspection continued on 12 December 2018 and was announced.

Deja Vu is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 is registered to provide accommodation for persons who require nursing or personal care. It is registered for up to seven people with learning disabilities and autistic spectrum disorder. At the time of our inspection there were six people living in the home.

The home was a two-storey detached property which had an open plan kitchen dining area, and three bedrooms on the ground floor. On the first floor there were four further bedrooms. There was also a communal lounge with access to an enclosed garden and a sensory room.

The care service had been developed and designed in line with the values that underpinned the Registering the Right Support and other best practice guidance. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen.

The service had a registered manager in post. 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 our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of seizures, or behaviours which may challenge the service, staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

Where possible people had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People’s eating and drinking preferences were understood and their dietary needs were met. Opportunities to work in partnership with other organisations such as community learning disability teams took place to ensure positive outcomes for people using the service. 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.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported to express their views about their care using their preferred method of communication and were actively supported to have control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. Equality, Diversity and Human Rights (EDHR) we

This inspection was carried out on 28 and 29 June 2016 and was unannounced.

Deja Vu provides accommodation and personal care for up to seven people who have learning disabilities. Support is carried out in an extended property, with widened corridors in the downstairs area to support people who may also have a physical disability. At the time of our inspection there were six people using the service. There was a large garden with a decked area and a sensory garden at the bottom.

Deja Vu has a registered manager in post. 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 the last inspection on 17 and 23 March 2015 we asked the provider to take action to make improvements to person-centred care planning, safe care and treatment, governance and the implementation of the principles of the Mental Capacity Act 2005. This action has been completed.

Staff had received safeguarding training and were able to describe sources and signs of abuse and potential harm. Staff were aware of how to protect people from abuse. Relatives told us their family member felt safe.

Risk assessments, referred to by the provider as support guidelines, were in place for each person on an individual basis. People using the service were living with a learning disability and were at risk from a large number of everyday activities. Staff were aware of the risks and knew how to mitigate them.

Incidents and accidents were recorded appropriately and investigated where necessary. Any learning or changes to support plans or support guidelines were discussed at staff meetings. Where necessary investigations were carried out.

There were enough staff on duty to meet people’s needs. The registered manager explained how staffing was allocated based on how many people had been assessed as requiring one to one support and the known needs of the other people using the service. Recruitment was carried out safely to ensure that potential members of staff were suitable to work in the home.

Medicines were administered safely by staff who had been trained to do so. Medication competencies were checked by the registered manager annually. Medication Administration Records (MAR) were kept for each person. Medicine stock levels were monitored and recorded on a daily basis by the member of staff administering medication. Medicines were also checked weekly and monthly.

People were asked for their consent before care or support was provided and where people did not have the capacity to consent, the provider acted in accordance with the Mental Capacity Act 2005. This meant that people’s mental capacity was assessed and decisions were made in their best interest involving relevant people. The registered manager was aware of her responsibilities under the Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications for people using the service.

Relatives told us they were very happy. Staff understood people’s preferences and knew how to interact and communicate with them. People behaved in a way which showed they felt supported and happy. People were supported to choose their meals. Snacks and drinks were available in between meals. Staff were kind and caring and respected people’s dignity.

Support plans were detailed and included a range of documents covering every aspect of a person’s care and support. The support plans were used to ensure that people received care and support in line with their needs and wishes. We saw this reflected in the support observed during the visit.

There was evidence in support plans that the home had responded to health needs and this had led to positive outcomes for people.

There was an open and transparent culture within the home. Staf

This inspection was carried out on 17 and 23 March 2015 and was unannounced.

Deja Vu provides accommodation and personal care for up to seven people who have learning disabilities. Support is carried out in an extended property, with widened corridors in the downstairs area to support people who may also have a physical disability. At the time of our inspection there were seven people using the service. There was a large garden with a decked area and a sensory garden at the bottom.

Deja Vu has a registered manager in post. 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 the time of our inspection the registered manager had been in post for five weeks.

People’s support plans included risk assessments, however these were incomplete, not always accurate and in some cases contradictory. This made it difficult for staff to respond appropriately to identified risk. We identified some areas of risk which had not been considered by the provider and were therefore not responded to.

People were protected from the risks of abuse, because staff had received safeguarding training, were able to recognise and describe signs of abuse and knew how to report suspected abuse. The provider encouraged staff to report any concerns.

Staffing levels were planned and matched to people’s assessed needs. Although there were sufficient staffing levels on both days of the inspection, on the first day there were significant numbers of agency staff. The provider was working hard to reduce the number of agency staff. There were suitable processes in place in relation to the recruitment of staff.

Medicines were stored and administered safely by staff who had been trained to do so. Staff had received medicines and epilepsy training in order to administer emergency medicines in relation to seizures.

The registered manager considered that everyone had capacity to consent to everyday care and support in the home. However, we found several areas where people had received medical treatment and it was not clear that the Mental Capacity Act 2005 (MCA) had been followed. The MCA is a law that protects and supports people who do not have the ability to make decisions for themselves. Where people lack capacity to make specific decisions the home should act in accordance with the principles of the MCA.

Staff had received essential training to deliver the care and support for people living in the home, however some care plans stated that some people communicated using Makaton. Makaton is a language programme using signs and symbols to help people to communicate. Staff had not received training in the use of Makaton, and we did not see staff using Makaton during the inspection. This meant staff may not have been able to communicate effectively with people.

The Care Quality Commission (CQC) monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and was aware of a recent Supreme Court Judgement which widened and clarified the definition of the deprivation of liberty. Relevant applications had been submitted for people.

People chose meals on a weekly basis by pointing at pictures of different kinds of food. Staff managed the food pictures to ensure that the overall weekly menu was healthy and balanced. The daily menu was clearly displayed in the kitchen for people to see.

We observed staff behaving respectfully towards people, responding to vocalisations and using opportunities through music and singing to interact with people.

Many of the bedrooms were not personalised in accordance with people’s known interests and personal preferences. Some were cluttered by general items such as cardboard boxes, blue roll and hand towels and did not meet people’s physical needs. Most rooms had a neglected and uncared for appearance.

Decision making profiles were included within support plans. However, these were not consistent with communication plans. This made it difficult to ascertain to what extent people had been involved in decision making around their care. Most care plans stated that the person had a learning disability and therefore was not able to be involved in their support plan. However, there was no evidence that this had been tested to ensure people were involved as much as they were able to.

We observed staff to be caring and supportive, engaging in activities with people such as reading books, playing instruments and games and colouring. People smiled showing they enjoyed the interaction.

People’s support plans included a range of documents to support their care. However, not all parts of the plan were properly completed or up to date. Some plans were not clear or there were multiple plans which contradicted one another. The plans were not in a consistent format and did not accurately describe everyone’s needs. There were no person centred plans in place. This made it hard to see how responsive personalised care was fully being offered.

People took part in activities at a local day centre, went for walks and engaged in cooking and other household chores as far as they were able. There was no evidence that activities were part of a person centred plan around the person’s known hobbies and interests, or directed towards identified goals and aspirations.

The registered manager held regular staff meetings at which she actively encouraged feedback from staff. A detailed agenda was on the wall in the office in preparation for the next meeting and staff were able to add other agenda items they wished to discuss. Staff said they felt listened to by the manager, and felt confident that any concerns raised would be appropriately responded to.

The registered manager had only been in post for five weeks at the time of our inspection, therefore it was difficult to evidence a positive culture in such a short space of time. However, staff were positive about her appointment and were supportive of the changes and improvements she planned to make. They found the registered manager to be approachable, honest and open.

The vision and values for the provider were clearly displayed in the office and these included passion for care, positive energy and freedom to succeed. A clear vision and set of values had not yet been developed at a service level. Once these had been developed staff would be able to ‘buy in’ to the future of the home and contribute to its potential to succeed.

Appropriate Care Quality Commission (CQC) notifications had been submitted and there was an open and honest working relationship, which meant the registered manager openly discussed any issues with a view to ensuring swift and appropriate action.

The service required improvements across the board. The recent appointment of the registered manager meant that she had not yet had time to instigate real change; however she told us she had plans to do so.

During our inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 corresponding to four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.