Coldwells House 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.

Coldwells House accommodates up to 41 older people with dementia in one adapted building. The service also provides specialist care for people living with dementia, mental health needs and physical disabilities and older people. There were 39 people living in the home when we inspected.

At the last inspection in January 2016 the service was rated as Good overall, and outstanding in Caring. At this inspection we found the service had improved to Outstanding overall.

Why the service is rated Outstanding.

People consistently received very supportive and compassionate care which they said made it a pleasure to live at the home. People showed us they had developed exceptionally strong bonds with the staff who supported them.

Staff were passionate about providing warm and considerate care. To facilitate this, staff had developed an in-depth knowledge of people’s unique histories, interests and communication preferences. Staff skilfully and imaginatively used this knowledge when caring for people; people were empowered to make their own decisions and to enjoy the best well-being possible. Staff were proactive in promoting people’s dignity, privacy and independence.

People enjoyed a very wide range of interesting things to do. Staff very thoughtfully devised tailored opportunities for people to creatively express themselves. These were based on people’s individual histories and preferences, and built on people’s links with the local community. This ensured people were connected with their past, their relationships with people who mattered to them were promoted, and their achievements were celebrated.

Systems supported people to make any complaints they wished to. People and their relatives advised us they would be confident to make any complaints, but had not needed to because the quality of care provided was very good.

We found relatives had been very positive about the compassionate action taken by staff at the end of their family member’s lives.

People’s care needs were comprehensively and sensitively assessed by staff, who focused on finding solutions to people’s complex support needs. Staff were exceptionally skilled at supporting people so they enjoyed an enhanced quality of life.

People highlighted how much they enjoyed their meals, which were pleasurable, social occasions with relatives and staff. People enjoyed improved health because their nutritional and hydration needs were fully met.

There were very good systems for working across staff teams and with external specialists, with clear evidence of people achieving greatly improved physical and mental health. A healthcare professional who regularly visited the home commended staff for their commitment to improving people’s health and well-being.

The needs and wishes of people were central to how the home was used. People and their relatives enjoyed using the onsite café and benefited from meeting up in quieter or more lively areas of the home and gardens.

Staff had used discreet symbols to let people know they would be valued for themselves, and their lifestyles would be respected. Staff were proactive in promoting people’s freedoms and respected their rights. 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 told us they loved living at the home and staff felt very supported. The culture in the home was open, and all staff teams consistently focused on improving and further developing people’s care. The management team had developed ways of working across organisations to support staff to provide excellent care, so people’s care expectations

People told us that they were happy with the care and support provided at the home. Comments included, "I'm really pleased with everything here", "I can't fault anything" and, "the care is very good". We saw that staff were caring and kind in the way that they supported people.

Staff understood the importance of people making decisions for themselves as far as they were able. Some people were living with dementia and were not able to make some decisions for themselves. There were clear procedures in place to ensure that decisions were made in people's best interests.

We saw that people appeared well cared for. Staff were attentive to people's needs. People told us, "the staff are fantastic" and, "they'll do anything for you". Records were detailed and fully completed.

People told us that they enjoyed the food provided at the home. One person described it as, "as close to home-cooked as you can get". Staff supported people to eat in a sensitive and gentle manner.

The provider had effective systems in place for monitoring the quality of the service. People were encouraged to express their views and opinions about the home. Any concerns were acted upon promptly.

Many of the people who were living at Coldwells House had a dementia type illness and so were not able to comment directly on the care and support provided. We spent time in communal areas such as the lounge, so that we could see how staff supported people. We also spoke with people in their own rooms and with relatives, staff and the manager. People were positive about the home, and spoke warmly about the staff, describing them as “so kind and cheerful” and “good at looking after us all”.

We saw that people looked well cared for and were wearing clothing appropriate for the time of year. People told us “we’re always busy here” and mentioned some of the activities provided at the home, such as exercise classes and a gardening club. One person showed us photographs of the recent fete, which were being displayed on a touch screen in the lounge.

We saw that staff were taking time to listen to people’s requests and were supporting people respectfully. We saw that people were given choice throughout our visit, such as what they would like to eat, and what they would like to do.

People told us that they were confident that they could approach the manager with any concerns, and one person said “she’d put things right, no problem”.

This inspection was carried out on 13 and 14 January 2016 and was unannounced.

Coldwells provides accommodation and personal care for up to 33 people. At the time of our inspection there were 29 people living at the home.

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 and associated regulations about how the service is run.

People were treated with dignity and respect and had good positive relationships with the staff that supported them. They were supported by staff who were motivated and well trained. They said that staff were kind, knew their health needs and they received support when they needed it. There were staff who took the lead for various aspects of the care and support that people received. This included areas such as dementia and nutrition. Medicines were managed safely and people received their medicines in line with their prescription.

People felt safe and knew how to raise concerns. Staff felt comfortable to raise any concerns about people’s safety and understood about how to keep people safe.

People said that they were able to make choices about the food they wanted to eat. They told us that they enjoyed the food. Where additional monitoring and support was needed this was provided.

People had access to other health professionals and were referred to them by the registered manager if there were any concerns about their health needs.

People told us the registered manager, provider and staff were approachable, willing to listen to their views and opinions.

People were encouraged to be actively involved in the running of the home through regular meetings. They felt that if they had any concerns they were able to speak with the registered manager or provider.

Staff were well supported and had access to regular training and supervision. Staff felt that they were able to contact the registered manager or provider at any time if they had a concern.

There were a range of audits and checks to make sure that good standards of care and support were maintained. Feedback from the people  and relatives was gathered on a regular basis and where any actions were identified theses were actioned quickly.