This inspection took place on the 4 and 6 April 2017. The first day of the inspection was unannounced.

The service is registered as a care home providing nursing care for up to eight people with a learning disability and /or associated mental health need. Each person has their own self-contained flat and receives one to one support depending on their assessed need. At the time of our inspection there were five people living at the home. The service supported people with complex care needs and associated behavioural issues.

The service had a registered manager in place. 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. The registered manager was also a registered mental health nurse. They were supported by a registered learning disability nurse.

The service was previously inspected in March 2016 where we found three breaches of the Health and Social Care Act 2008 in relation to assessing and mitigating risks, obtaining people’s consent for their care and treatment and staff training. At this inspection we found improvements had been made in all three areas.

People we spoke with and professionals involved with the service were complimentary about the care and support provided by Cheshire House. People said they felt safe and that the staff knew their needs a well. The staff we spoke with showed they had a good understanding of people’s needs. There were sufficient staff on duty to meet people’s needs.

Care plans, risk assessments and positive behavioural plans were in place. Clear guidance was provided for staff to support people and mitigate the identified risks. The service worked closely with the community learning disability team (CLDT) to support people manager their behaviours. The care plans promoted people’s independence where appropriate and were evaluated regularly. Staff knew the guidance in place to support each person safely.

Incidents were analysed and de-briefs were held with the staff team, the provider’s behavioural specialist and the CLDT to learn from each incident. The behavioural support plans were updated as required following an incident.

Staff had received suitable training for them to undertake their role. This included specialist training in areas such as mental health and personality disorder. Staff had completed training in safeguarding vulnerable adults and explained the types of abuse and the action they would take if the witnessed or suspected any abuse had taken place. New staff received a comprehensive induction to the service and people’s needs.

Staff received regular supervisions from the team leaders. The registered manager supervised the team leaders. Regular team meetings were also held. Staff told us these were open forums where they were encouraged to contribute to the discussions and raise any ideas or concerns.

Staff said they felt well supported by the registered manager and behavioural specialist. They were positive about the changes in the management structure and the introduction of key workers. They said they were now more involved in developing people’s care and support and liked the increase in responsibilities.

A robust procedure was in place for assessing people referred to the service. The registered manager and behavioural specialist completed an initial assessment and were able to state if the person could or could not be supported by the service. Staff were also involved in visiting people before they moved to the service so they could get to know them and their needs.

During the inspection we observed and heard kind and respectful interactions between the people who used the service and the staff team. People told us they liked the staff who supported them. People were supported