The Lustrells is a small home care home registered to provide accommodation, care and support for up to four younger adults with physical disabilities or learning disabilities or autistic spectrum disorder. The home is a detached split level bungalow with two floors and a garden. It is situated in a residential area, near to the local shops. The inspection took place on 29 June 2017 and was the first inspection since the service was registered in November 2015.

There was 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.

Not all risks to people were being effectively assessed and managed. Potential risks associated with an enteral feeding system had not been identified and the care plan lacked guidance for staff in how to manage the system. Risks associated with pressure care had also not been assessed and plans were not in place to guide staff. This was identified as an area of practice that needed to improve.

Other risks had been assessed, managed and were regularly reviewed. People were supported to maintain their freedom and there were clear plans in place to guide staff. Staff had a firm understanding of how to safeguard people from abuse and understood their responsibilities in this regard. There were enough staff on duty and the provider had robust recruitment procedures to ensure that staff were suitable to work with people. People received their medicines safely. One relative said, “Any concerns are acted upon very quickly, I’m sure people are safe.”

Staff had received the training and support they needed to be effective in their roles. One staff member said, “The training is very good and gives us peace of mind that we are doing things right.” Staff understood the principles of the Mental Capacity Act 2005 and sought consent from people before providing care or support.

People were supported to have enough to eat and drink. Meals were provided according to the needs and preferences of each person. Where nutritional risks and needs had been identified there were clear plans in place to guide staff in how to support people. Staff were proactive in ensuring that people had access to the health care services they needed. A visiting health care professional told us that staff were “Helpful and knowledgeable about people’s needs.”

Staff knew people very well and had developed positive relationships with them. People were relaxed and comfortable in the presence of staff and we observed many interactions that demonstrated the closeness of their relationships. People were smiling and laughing with staff throughout the inspection and displayed affection openly. Staff treated people with respect and preserved their privacy and dignity. Staff encouraged people to make choices and to express their views.

Care plans were detailed and written in a personalised way. They provided a clear picture of the individual and guided staff in how to provide care that was responsive to the needs of the person.

People were being supported to lead full and active lives. Activities were arranged in response to people’s individual interests and included regular trips out in the local community. One relative told us, “I can visit at any time but I phone first because they are always out and about doing something nice.”

Feedback was used to improve the service and a complaints system was in place. Relatives told us they would feel comfortable to raise any concerns. The registered manager provided clear leadership and staff and relatives spoke positively of recent changes. One relative told us, “The new manager has different expectations, we have noticed the difference.” A staff member said, “There have been a lot of change