This inspection was carried out on 31 October and 2 November 2018 and was unannounced on the first day.

Clara 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. Clara Court accommodates 76 people in one adapted building. At the time of our inspection there were 71 people using the service.

The service accommodates people across three separate units, each of which have separate adapted facilities. All of the units specialise in providing care to people living with dementia.

The service is required to have a registered manager to manage the service. At the time of our inspection 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.

At our last inspection in 2016 we rated the service good. At this inspection we found the service had improved and evidence supported the rating of outstanding. There was no evidence or information from our inspection and ongoing monitoring that demonstrated concerns.

We received positive comments from people and their relatives about the service. One relative told us, “Do they look after her, I should say so. They care for her so lovingly and respectfully. The care they provide to her is like family care.” Other comments included, “Yes definitely, she actually says she feels safe”, “Yes, from what I have seen, yes”, “There always seems to be plenty [of staff] about. This view is shared by my other two sisters as well.”

Staff we spoke with told us they would not hesitate to report any concerns to the relevant authority. Policies in relation to safeguarding and whistle blowing reflected local procedures and relevant contact information. People’s medicines were managed so that they received them as the prescriber intended.

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.

A robust recruitment process was in place to ensure prospective new staff had the correct skills to support people living at Clara Court. There were sufficient staff available to provide support to people to ensure their safety was protected.

Staff developed good relationships with people and their families. Relatives told us staff were considerate and looked after their family members well.

The service supported people at the end of their life. End of life care plans included people’s wishes and thoughts to ensure their remaining days were as peaceful as possible.

The environment created a homely atmosphere and consideration was given to the requirements of people living with dementia.

Many of the staff had worked at the service for several years. The provider continually recognised their contribution in providing a good service and worked in partnership with other organisations to further develop the service.

Staff knew about people’s dietary requirements. Snacks and drinks were available throughout the day.

Activities and social events took place to avoid social isolation. Relatives and friends could visit without restrictions.

Clara Court is a residential home located in Maidenhead. It provides accommodation for up to 76 people who require personal care and support on a daily basis. The home cares for older people who are physically and/or mentally frail and people living with dementia. Clara Court does not provide nursing care.

Clara Court is a purpose built care home situated over three floors. The service had a light, airy and homely feel and was kept clean and tidy. The home had a lift which meant people with mobility issues could access all areas of the service. One person commented “Lovely and clean, not a speck of dust.”

People, relatives and professionals were extremely complimentary about Clara Court. Comments included “Yes they do look after me very well. Very happy here”, “Very good care - can’t grumble about anything”, “Oh yes! They look after us so well. Get what you need. Lovely caring people”, “Carers brilliant - care brilliant, couldn’t be better”, “Wonderful care by kind people”, “Staff very loving, sense of humour, good rapport”, “Staff take time to introduce X to new carers”, “Carers supportive, senior people really very good and supportive”, “Carers brilliant. Everything I have seen is superb. Very focussed care”, “First, when came X came in she was worried but now for the last 5 months no tears and has settled thanks to the care she has received”, “100% sure. Over the moon about this place. So impressed with every member of staff” and “Care is beyond expectations.”

People were treated with dignity and respect by staff who were kind, considerate and caring. We made good observations of staff engaging people in conversations, kneeling down next to people to be at their level and responding quickly to people’s requests. Discussions with staff demonstrated they knew people’s needs well and knew how to support them in a person-centred manner. Staff also promoted best practice when working with people with dementia to enable them to have fulfilled lives.

Throughout the inspection, we found common themes of ‘Choice’, ‘Striving for excellency’ and ‘Clara Court is their [The people who lived at Clara Court’s] home. One staff member told us “This is the person’s home. They should get what they want, when they want it and how they want it.”

There was clear management oversight of the service and efficient procedures in place to ensure the service was run well and people were kept safe.

Plenty of activities were provided to people living at Clara Court by activities co-ordinators who had a clear passion for their roles. We saw staff were dedicated and hard working to ensure people were kept safe and well.

Staff received an array of training in order for them to be competent in their roles. Staff also received regular supervision to update their knowledge and skills. People’s medicines were managed well to ensure their safety.

We observed good use of dementia aids and tools to support people living with dementia. People were supported to receive appropriate nutrition and hydration and procedures were implemented to ensure people had enough to eat and drink. Staff took their time to support people in a person-centred manner. People’s health was promoted through good links with health community professionals.

We spoke with people who live at the home and relatives of people who live at the home. One person told us "its a really good home". A relative told us their relative "loved it" at the home and that they had been "praying they would get a place here". People were treated with respect and they were encouraged to remain independent and active within the home and the community.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person living at the home told us the staff "are very good, kind and helpful". Care records were easily accessible by all staff and were reviewed and updated regularly to reflect any changes in people's care.

The home appeared clean and there were policies in place for the management of infection control. Training in infection control was considered mandatory for all staff and we saw that staff had either received training or were booked to undertake training. One relative told us they felt the home was "lovely and clean".

There were effective systems in place for the recruitment of staff and appropriate checks were carried out before people began work at the home.

The provider had effective systems in place to monitor the quality of the service. There were regular resident and relatives meetings and an annual survey was carried out of the people who used the service. Regular quality audits were carried out by the provider and action was taken to address any issues arising.

We spoke with 11 people who lived at the home, one relative, two social care professionals and ten staff during our inspection of the service. People told us they were very happy at the home. They said they were comfortable and well cared for by "lovely, friendly staff". They said the food was well presented and "nicely cooked" and there was plenty of variety. People said they had "nice" bedrooms that were individually personalised to reflect their particular tastes and interests.

One person told us "it's lovely here, staff are kind and friendly and the food is good". Another said "it’s a nice place to live". We spoke with a relative who said " it took X about six weeks to settle in but they are now very content". They said "the staff are approachable and kind".

People who use the service told us that staff were good at respecting their privacy and would knock on doors before entering. Those that were able to care for themselves said they felt independent. They told us their decisions were generally well respected by staff.

People said they had been able to visit the service to see if it was suitable for them. They said they had been asked about their needs and staff displayed an awareness of these needs. They told us there was a good selection of activities arranged for them which on the whole they enjoyed.

They told us they felt safe living at Clara Court and that staff were good at responding to call alarms when they needed them. They said that the staff were always able to do what was required of them. People said that staff were generally respectful to them and they were mostly comfortable with the way they were treated.

The people we spoke with said they had never needed to raise a concern and weren’t sure who to approach if they had a concern. They said they often saw the manager and found him easy to talk with. They could not recall completing a questionnaire or attending a meeting to give their views and opinions on their care or the service.

One person summarised her experience at Clara Court by saying: “My independence is respected here. Staff are good at letting me do my own thing. I feel all right here”. Another person said: “I haven’t been here long but feel I’m getting on just fine”.