Sidmouth Nursing Home is registered to provide accommodation for up to 29 adults who require nursing or personal care. The home has people with complex physical nursing needs and people with dementia or mental health needs. 27 people were using the service at the time of the inspection. One person was in hospital.

At the last inspection in September 2015 the service was rated good overall with caring rated as outstanding. At this inspection we found the service continued to provide outstanding care in the caring domain and had strengthened their practice in well-led, which is now rated outstanding. We found the management team had continued to develop the service and the culture and ethos was extremely positive and person centred. The safe, effective, and responsive domains remain rated as good. However, the service is now rated outstanding overall.

This comprehensive inspection was carried out on 23 and 25 October 2017. The first day was unannounced and announced on the second day.

A registered manager was 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.

The registered manager; management team and staff team were committed to ensuring people experienced an enhanced quality of life, which took into account individual wishes and beliefs. This meant people were valued and treated with equality. The inclusive ethos supported people to carry on living their lives, pursuing their interests and maintaining and building important relationships.

People consistently told us about the excellent care and support they received. People using the service, their relatives and visiting professionals said the service was “Exceptional”; “One of the best…” and “Excellent…” All said the service was safe. Comments included “They (staff) make sure I am safe”; “Mum has made it very clear to me that she feels safe and protected by the staff” and “I wish to state that the care at this nursing home is exemplary…”

People experienced exceptional high standards of care. End of life care was provided by staff who were skilled and competent and ensured effective pain and symptom management. Palliative care specialists and GPs were high complimentary of the care provided at the end of life. Comments included, “The care here is of a really high standard…They (staff) pre-empt people’s needs” and “The patient care delivery is in my opinion to a high standard taking into account the patient’s individual needs.”

People’s wellbeing and happiness was central to this service and the management and staff team actively promoted a person centred culture. Staff had developed a positive rapport with people and they were gentle, attentive, kind and respectful in their approach. People’s independence was encouraged and people were supported to do as much as possible for themselves. Comments included, “They (staff) are so marvellous” and “There is nowhere like it. You read terrible things…but here carers care.”

The culture within the service was open, friendly and welcoming. People, staff and professionals expressed a very high degree of confidence in the management team. The ethos created was open and transparent. The management team acted as role models for the staff team who were motivated to offer care that was kind, considerate and put people at the heart of everything they did. The management team placed emphasis on continuous improvement of the service and promoted links with the community, which benefitted people using the service.

People’s views were sought and taken into account in how the service was run. The provider made changes and improvements in response to feedback. There was a robust system of monitoring the service to identify any improvements that

On the day of the inspection there were 26 people living in Sidmouth Nursing Home. We reviewed five care records and other records relating to the management and administration of the service.

We spoke with four people who used the service, to the registered manager, the nominated individual and six other staff on duty. We also spoke to two visiting healthcare professionals. We observed how care and support was provided to people and how medicines were managed safely. We also looked at how staff were trained and supported to undertake their roles.

People told us they were very happy about how care and support was provided to them, and with the staff who provided that care. We were told that they had the help and assistance they needed. We observed that people had good relationships with the staff, people and staff interacted well. There was a friendly and welcoming atmosphere. People told us that they liked living in the home. One said “Its great. Staff are very kind” another that they “They look after me very well. They are very nice people.”

During our inspection there were 27 people living at the home. We spoke to four people, three people told us that they loved living at the home and one person told us that it was “really good”.

We saw that people were treated in a dignified manner. One staff member told us that they felt it was a “privilege” to work with the people and therefore it was only natural to treat them with respect.

Treatment and care was planned and carried out to ensure both the safety and the happiness of people. We saw clear care plans and observed aspects of these care plans being incorporated into care.

Staff looked after people with tenderness and expertise. People living at the home and their family members spoke highly of the staff. One family member told us that they couldn’t “recommend the staff highly enough. They look after [people] as if they were their own”.

The manager operated an ‘open-door’ policy and people, their families, and staff told us that they felt the manager was approachable and kind.

There were 28 people using services when we carried out an unannounced visit to Sidmouth Nursing Home. People living at the home said that they enjoyed living there. One person using the service said ‘it’s lovely here, fabulous how they care for you, the staff are getting used to my little ways’.

We saw staff interacting with people using the service in a respectful way, spending time with people using the service and chatting. People using the service said that they were comfortable with the staff saying that ‘they are all lovely’. We saw that a good rapport had developed between people using the service, relatives and friends and the staff team. The service has a very low staff turnover. One person using the service said that they could not fault the staff who ‘cannot do enough for them’. Other people using the service said ‘it’s a happy place’. Everyone we spoke to using the service had positive comments about their care and life at the home.

No-one spoken to had any problems with the meals or showed any negative signs when asked about food. Food was presented in an appetising and sociable way and there were condiments available. Attention is given to ensuring that people using the service are able to eat things that they like and as much or as little as they like in a lovely setting.

Staff said that they enjoyed working in the home. Most of the staff have been working at the home a long time and therefore know people living at the home very well. Staff said that ‘we are very lucky here, the manager is really good and everyone is passionate about the job’.

Staff and the manager were able to describe how they managed individual peoples' needs in good detail and that they understood how to promote a homely atmosphere. Staff know how to protect people and keep them safe. Records are good and staff showed that they knew people using the service well and people using the service said that their needs were well met. The only negative comment from people using the service would be that staff sometimes do too much for people.

We found the home to be clean and staff were following infection control procedures. There has been a lot of investment in the environment such as new floors in all the bedrooms, a new sluice and a beautiful thatched undercover seating area on the patio.

We carried out a comprehensive inspection on 1 and 3 September 2015.

Sidmouth Nursing Home is registered to provide accommodation for up to 29 adults who require nursing or personal care. The home has people with complex physical nursing needs and people with dementia or mental health needs. There were 28 people using the service on the first day of our inspection. We last inspected the service in January 2014, at that inspection the service was meeting all of the regulations inspected.

The responsible individual was in day to day charge at the service and everyone referred to her as ‘The manager’. The service had a registered manager who was known at the home as ‘Matron’ who was mentoring a clinical lead nurse to apply for the role when they stepped down and took on lighter duties. 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.

Everyone gave us positive feedback about the responsible individual and the registered manager and that they were very visible at the service and undertook an active role. They promoted a strong caring and supportive approach to staff as they felt this was then the culture in which staff cared for people at the service.

Staff were compassionate, treated people as individuals and with dignity and respect. Staff knew the people they supported, about their personal histories and daily preferences. Staff showed concern for people’s wellbeing in a caring and meaningful way. They showed people compassion and had developed warm and caring relationships with them.

The provider and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) (2005). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

People were supported by sufficient staff who had the required recruitment checks in place, were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

People were supported to eat and drink enough and maintain a balanced diet. People and relatives were very positive about the food at the service. People and relatives were seen to be enjoying the food they received during the inspection.

People received their medicines in a safe way. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Where possible, people were involved in making decisions about how they were looked after. People and relatives said staff were caring and compassionate and treated everyone with dignity and respect at all times. The service made sure staff knew how to manage, respect and follow people’s choices and wishes for their end of life care and as their needs changed. There was a clear message given to us from staff that they treated everyone at the service as their own family.

People had the opportunity to partake in a range of activities which were personalised to their preferences.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people where able and their families had been involved in their development. Accidents and incidents were reported and action was taken to reduce the risks of recurrence.

People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support. Healthcare professionals were very positive about the quality of care provided at the home and the commitment of the whole team to provide a good service.

The premises were well managed to keep people safe. There were emergency plans in place to protect people in the event of a fire or emergency.

The provider had a quality monitoring system at the service. The provider actively sought the views of people, their relatives, staff and outside professionals. There was a complaints procedure in place, although the service had not received any complaints the responsible individual had responded to niggles to the same level.