This inspection took place on 21 and 24 January 2019 and was unannounced. Coloma Court 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 care home accommodates 62 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of our inspection 61 people were living at the home.

At our last inspection on 18 and 19 July 2016, we rated the service good overall with an outstanding rating in caring. We found that the home provided outstanding end of life care and people experienced a comfortable, dignified and pain-free death. Since that inspection our key line of enquiry [KLOE] relating to end of life care has moved from caring to responsive. Our evidence relating to end of life care is referred to in responsive.

The home 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 and associated Regulations about how the service is run.

The home was outstanding at responding to people’s needs. The home's website stated, "Our aim at Coloma Court is to preserve and maintain the dignity, individuality and privacy of all residents. Achieving that aim involves working with each resident to provide care in ways that suit them.” It was evident throughout the inspection that management and staff worked hard to achieve these aims.

People and their relatives told us they received personalised care which met their individual needs and preferences. The homes’ dedicated admiral nurse provided practical, clinical and emotional support to people living with dementia and their family members. They ran a daily ‘advice drop in’ service for relatives to access. People were supported to meet their spiritual and religious needs by the provision of daily services and the Christian ethos of the home was reflected in the attitude of the staff and their approach to care. The home provided outstanding end of life care and people experience a comfortable, dignified and pain free death. The home was proactive in raising awareness of other cultures. Staff knew people well and understood their needs. People were provided with a range of appropriate social activities that met their needs. The home had a complaints procedure in place and people and their relatives said they were confident their complaints would be listened to and acted on.

People, their relatives, health professionals and staff felt the service was very well led. We received very positive feedback about the way the home was run. The provider took steps to ensure people and their relatives were involved in the developments at the home. The management team motivated and encouraged staff to develop their professional and leadership and skills. Staff were consistently positive about the leadership provided by the registered manager, deputy manager and the unit managers and about working at the home. The home was part of a group of care homes that empowered and supported staff to provide individualised, skilled and effective end of life care for their residents. The homes admiral nurse had delivered talks on dementia awareness to people in the local community and further engagements to continue these throughout 2019. Audits were conducted to ensure the quality of care and environmental issues were identified promptly. Accidents were investigated and, where there were areas for improvement, these were discussed during managers and unit meetings to reduce the likelihood of these incidents reoccurring.

People using the service said they felt safe

This inspection took place on 18 and 19 July 2016 and was unannounced. Coloma Court Care Home provides nursing and residential care for up to 62 older people. At the time of our visit 62 people were living there. At our last inspection on 20 November 2013, we found the provider was meeting the regulations in relation to the outcomes we inspected.

The home 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 and associated Regulations about how the service is run.

The service provided to people was extremely caring. The home provided outstanding end of life care and people experience a comfortable, dignified and pain- free death. Health care professional told us there were excellent arrangements in place to meet people’s end of life care needs. The home had been accredited the Gold Standard Framework (GSF) Beacon status for the high quality of care they provide to people in their final years of life. Beacon status is the highest level. Staff regularly attended training provided by a local hospice in order to learn and develop their practice in supporting people at the end of their lives. People valued their relationships with the staff team. Staff enabled people to remain independent and understood people’s individual needs around privacy and dignity. There were regular relatives and residents meetings and people told us their views and opinions about the home were listened to and acted on. Some people using the service participated in the homes recruitment process.

People using the service said they felt safe and staff treated them well. Appropriate recruitment checks took place before staff started work. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed an induction when they started work and they were up to date with the provider’s mandatory training. The registered manager, unit managers and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to ensure that people were receiving the food and fluids they needed.. People had access to a GP and other health care professionals when they needed them.

Staff knew people well and treated them with understanding, compassion and dignity. People’s privacy was respected. People using the service and their relatives were provided with appropriate information about the home before they moved in. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. Care plans and risk assessments provided guidance for staff on how to support people with their needs. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

There were appropriate arrangements in place for monitoring the quality of the service that people received. The provider took into account the views of people using the service, relatives and staff through surveys. The results were analysed and action was taken to make improvements for people living at the home. The registered manager carried out unannounced visits to the home to make sure people where receiving appropriate care and support. Staff said they enjoyed working at the home and they re

People we spoke with were complimentary about their experiences of living in the home, including the care and meals provided by staff. People’s comments included; “the care is excellent and the staff are lovely”, “the carers are well qualified”, “a lot of care goes into cooking the food”, and “I would approach the manager if I had a complaint”. However, some people felt staff needed to be more prompt when attending to their care needs. In addition, a resident and relatives meeting was held on the day of our inspection, giving people an opportunity to comment on service delivery. We observed positive interactions between staff and people using the service during the delivery of care and at mealtimes.

The provider had suitable arrangements in place to gain and review consent from people using the service. We saw examples of best interest decisions made where a person lacked capacity to make a specific decision about their care. We found people's care needs were assessed, and most care plans were reviewed monthly to ensure people received planned and appropriate care. We saw that people were supported to have adequate nutrition and hydration to meet their individual nutritional needs. There were appropriate numbers of skilled and experienced staff to support people using the service. The provider had a complaints procedure in place which was shared with people using and accessing the service, and formal complaints raised had been fully investigated.

The people who used the service said that their wishes were respected in terms of personal care and they were happy with the way they were looked after. For example, one person liked to be washed by night staff so that they were the first person to be ready to have breakfast in the dinning room. The provider made appropriate arrangements to promote the wellbeing of people who use the services.

Staff we spoke with felt they were adequately supported. People told us that staff looked after them well and supported them as and when needed. We observed that people were being supported by staff that were patient and sensitive to their individual needs. For example, one person said “this lady is lovable and she tries her best to look after me”, another person said “staff help us, come and chat with us” and a third person said “I get coffee when I ask for it”.

We spoke with some relatives of the people who used the service who said they had no concerns to raise about the safety and welfare of their relative. They said they were happy with the care provided. One person said “it is an exceptional place; the home is the best ever”. Another person said “people who come here really want to be here”.

The provider used effective systems to regularly check that care was being provided safely and appropriately.

All people using the service we spoke to, and their friends and relatives, told us that they were involved in assessments and in developing care plans.

People told us that staff listened to and consulted them in decisions about their care and daily lives at the home, and that their privacy and dignity were being respected. People said staff looked after them very well and that staff were “brilliant”. Family members told us that the home was comfortable, had nice rooms and that the staff were caring.

People said that they received their medicines on time.

People were satisfied with the level and quality of services being provided by staff and management team.