This inspection took place on 13 and 14 November 2017. The first day of the inspection was unannounced which meant that the staff and provider did not know that we would be visiting.

At our last inspection of this service in October 2015, we awarded an overall rating of Good.

At this inspection we found the service had improved and was outstanding overall.

Mount Olivet 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. Mount Olivet accommodates 30 people who require nursing or personal care in one adapted building set over three floors. Mount Olivet has a range of communal areas for people and their relatives to use, including a conservatory with outstanding views. There were 26 people living at the home at the time of our inspection.

The home had a registered manager. 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.

Why the service is rated Outstanding:

On entering the home there was an exceptionally welcoming and friendly atmosphere. Staff were extremely compassionate, attentive and caring in their interactions with people. One relative told us, “The care here is top class.” Another said, “There is such a feeling of family and warmth here.” Mount Olivet’s principle aim was to ensure a supportive environment for people where quality of life was paramount.

People benefitted because Mount Olivet was extremely well led by an experienced and exceptionally proactive registered manager who was also a registered nurse and the homes clinical lead. They had an open leadership style, promoted a positive culture, and were committed to high standards of care and continuous improvement. The registered manager had taken the management of care at Mount Olivet to a new level of excellence.

People told us they felt safe at the home and with the staff who supported them, one person said “I feel quite safe here.” Relative told us, “It’s a safe place for my relative. I truly have peace of mind knowing my relative is here, and when I go away for a weekend or a few days, I do so knowing my relative is safe.” There were systems in place to keep people safe. We found staff were aware of safeguarding processes and now to raise concerns if they felt people were at risk of abuse or poor practice.

People told us, and we observed, that staff were kind and patient and respected people’s privacy. A visitor told us “I visit my relative two or three times a week and always find her clean and well dressed. It’s obvious to me that she receives the highest level of care.”

People, or their representatives, were involved in decisions about the care and support they received.

People were supported by staff to have personalised experiences, maintain relationships and build memories with family and friends who were important to them. People benefitted from staffs enthusiasm and passion to ensure that all social activities were person-centred, fun, and had meaning to each person.

People told us there were adequate numbers of suitable staff to meet their needs and to spend time socialising with them. The registered manager used a dependency tool to ascertain staffing levels. The provider had a robust recruitment process in place to ensure only appropriate staff were employed to work at the home to support people safely.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. The registered manager kept an electronic matrix to monitor staff training. Staff training was either up to date or plans for refresher course

We inspected Mount Olivet Nursing Home in January 2013 and found people’s care needs were not responded to in a timely manner. We carried out a follow up inspection on 31 July 2014 to ensure there were sufficient staff on duty who were able to keep people safe and care for the people living in the home.

We met all of the twenty people residing at the home and spoke with eleven people. We met and spoke with the newly appointed General Manager and spoke with three staff on duty during our inspection. In addition we reviewed five staff files and staff training certificates.

We considered all the evidence we had gathered under the outcome we inspected.

We considered our inspection findings to answer the question:

• Is the service safe?

This is a summary of what we found

Is the service safe?

We found sufficient staff on duty to meet people’s needs. We spoke to eleven people who used the service and they were all happy with the care provided. They said they were treated with respect and dignity by the staff. There were enough staff on duty to meet the needs of the people who received care at the home. People told us they felt safe living at Mount Olivet. People told us “Staff are good, kind and the call bell is answered quite quickly”; “Usually staff come quickly, they always say when they will be back if they are busy”; “Staff respect my privacy and dignity”. Staff told us “It’s a good, solid team, things are getting better”. We found there was sufficient staff on duty during our inspection and we observed that they cared for people in a thoughtful, considerate manner.

We, the Care Quality Commission, undertook a follow up inspection at Mount Olivet Nursing Home to look at the homes management of medicines which we found to be non-compliant at our last visit.

During the inspection on 5 November 2013 we looked at the medicines administration records of 14 people living at the home. We found gaps in these records for 11 of these people. Nurses had not always been signed if regularly prescribed medicines had been given to people.

At our previous inspection we also found two people’s charts where on one or more occasions, the recording did not correspond with the instructions on the chart about how the medicine should be given to that person. We also saw that one person had received a course of antibiotics where one more dose had been signed as given, than had been recorded as received into the home.

Following the issue of compliance action the provider sent us an action plan detailing how they were going to become compliant. At this inspection we found that this action plan had been completed and the home were compliant with regard to their medication management.

At the time of our inspection 18 people were living at Mount Olivet. We spoke with four of those people. We also spoke with one relative. Some people were not able to communicate with us verbally. We used observation to understand the experience of people who could not talk with us.

We observed that people appeared at ease and comfortable around care workers. People were treated with dignity and respect. They had opportunities to be involved in and shape their own care. Where people did not have the capacity to make decisions for themselves their rights were protected. People told us they felt safe and happy to live there. Comments included, "they are super, and they really look after me well."

We found that there were satisfactory numbers of staff on duty. Staff were well supported and had completed or were about to attend appropriate training. They knew people as individuals and were aware of each person's needs. The service had good relations with health care professionals and acted upon their advice.

The home warm, clean and the atmosphere was relaxed and friendly.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Records were kept securely. However not all were up to date.

We spoke with three visitors, people living at the service and a visiting physiotherapist on our inspection. We also had discussions with four members of staff and observed the care they delivered.

We found that Mount Olivet was providing overall a good standard of care to people. People we spoke with told us that the home's staff were very good. One person told us "I'm very well looked after. The girls are nice, very kind, I'm happy ...can't credit them too highly... they do little extra things in their own time". We saw people were being treated respectfully.

However we found that staff took a long time to respond to people's call bells. People told us this was in some instances up to an hour. In our discussions, people repeatedly told us the home was short of staff.

We found that medication was being managed well and we saw compassionate care being delivered to an individual who was receiving end of life care. Some of the care records and plans we saw did not contain much evidence that people were involved in developing their care plans, and some records were not completed in sufficient detail.

The provider has told us they have an ongoing maintenance project to replace carpets as and when necessary and full time maintenance to oversee the general maintenance and decor. We also saw new systems were being provided for records management and policies and procedures.

Mount Olivet is a care home, registered to provide accommodation and nursing and personal care for up to 30 people. Most of the people living at the home were older people requiring nursing care or those who may be receiving end of life care. At the time of the inspection there were 21 people living at the home.

The inspection took place on 12 and 13 October 2015 and the first day was unannounced. Two social care inspectors undertook the inspection on the first day, and one on the second day.

The home had previously been inspected in July 2014 and was found to be meeting the regulations.

The home had a registered manager. 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.

Prior to this inspection we had received information that people’s ability to be able to consent to their care and treatment had not been assessed in line with good practice.

A number of people living at the home had conditions that affected their ability to make decisions about their care and treatment, such as dementia or other neurological conditions. When people are assessed as not having the capacity to make a decision, a ‘best interest’ decision involving people who know the person well and other professionals, where relevant, needs to be made. Staff demonstrated a good understanding of the principles of the MCA and told us people were presumed to have the capacity to make decisions. The documentation relating to how the home assessed people’s capacity to make decisions about their care and treatment was not always clear. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection some people were being deprived of their liberty to maintain their safety, as the home had a keypad lock on the front door to prevent people from leaving the home unsupervised and we saw that authorisation had been sought to do this legally.

People spoke highly of the care they received. They told they felt safe and were supported by kind and caring staff. Comments included, “yes, it’s lovely here, I couldn’t wish for anywhere better”, “the staff are really nice, we have such fun” and “it’s fantastic here; they can’t do enough for you. It’s the Ritz.” People said they would speak with the registered manager, or any of the staff, if they had any concerns or wished to make a complaint. However, no-one had needed to do so as they were happy with the care and support they received

Some people were being nursed in bed due to their frail health and we saw they were treated kindly and with patience. Their care needs were well documented indicating their needs were being met and they were receiving safe care. We saw staff in pleasant conversations with people and it was obvious staff had genuine affection for people. When staff entered people’s rooms we heard them explaining why they were there and what they were doing. Relatives told us they felt their relations were safe. One relative said, “I can relax; I know she’s being cared for – it means a lot.”

Care planning and risks to people’s safety and well-being were assessed prior to people moving into the home, were well managed and regularly reviewed with the person and their relatives, should the person not be able to contribute to the review themselves. People had prompt access to their GP and other health care professionals as needed, such as occupational therapists and the community speech and language team. People’s medicines were managed safely with only nurses administering medicines. People receiving care at the end of their life had medicines prescribed in anticipation of their needs to ensure they remained comfortable and pain free.

People told us they liked the food and had a good choice available to them. Comments included, “lovely food”, “excellent food” and “I really like the food.” During the inspection we saw people offered fresh homemade lemonade and fruit smoothies as well as hot drinks and biscuits, homemade cake and fruit. Some people required assistance with eating and drinking and we saw people were supported to eat in a manner that respected their dignity. Where people had been identified as at risk of not eating or drinking enough to maintain their health, records were maintained of how much they had eaten or had to drink during the day and these were reviewed daily by the nurses on duty.

There were sufficient staff on duty to meet people’s needs. Staff were recruited safely and received training to ensure they were knowledgeable about people’s care needs. They had received training in safeguarding vulnerable adults and they demonstrated a good understanding of how to keep people safe and how and to whom they would report any concerns to. They told us they enjoyed working at the home, one staff member said, “I love working here, we all work well together” and another said “I’ve been here a long time and I really enjoy working here.” A nurse told us this was the “best” nursing home she had worked in.

The home had planned activities each week and these were either provided by the staff or people coming into the home, and included games, musicians and animal petting. Work was underway to provide Wi-Fi access for all rooms to enable people to keep in touch with family and friends via computers.

People and their relatives as well as the staff told us the home was well managed. The relatives we spoke with told us there was good communication with the home and they were kept fully informed of any changes in their relative’s condition. The registered manager regularly met with people and their relatives individually to discuss in private their views and how well they felt they were being cared for.

The premises and equipment were maintained to ensure people were kept safe and monthly audits were carried out to review health and safety practices. The environment was very homely and clean throughout with no unpleasant odours. The communal rooms and many of the bedrooms had beautiful views over the Bay. The conservatory had binoculars for people to use, however, the room was hot and one person said they rarely used it as it was often too hot.