Mount Olivet Nursing Home

Mount Olivet is a residential care home providing personal and nursing care to up to 30 people. The service provides support to older people. At the time of our inspection there were 22 people using the service.

People’s experience of using this service and what we found

Risks to people's health, safety and welfare had been identified and guidance was in place to manage risk. However, risks to people were not always managed effectively as monitoring charts were not being completed consistently in relation to skin care and nutrition.

People did not always receive their topical medicines as prescribed for them. Topical administration medicines records were in place, but these were not always completed to demonstrate creams had been applied. Sufficient guidance was not in place for people prescribed oxygen.

Quality assurance and governance systems in place to assess, monitor, and improve the quality and safety of the services provided had not identified all of the issues we found during this inspection.

During the inspection we observed there were enough staff to care for people effectively and safely. However, people and their relatives told us they sometimes had to wait for care. We made a recommendation about this.

People told us staff were kind, caring and treated them with dignity and respect. People were encouraged and supported to remain as independent as possible and were supported to make decisions about their care.

The registered manager promoted a positive, person-centred culture within the service. People were very positive about the registered manager and told us they were approachable and very ‘hands on’.

People told us they felt safe. Staff had received safeguarding training and recognised different types of abuse and how to report it.

Recruitment processes ensured that, as far as possible, only suitable staff were employed to look after people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were protected from the risk and spread of infection. Staff were using personal protective equipment (PPE) in accordance with the government guidance.

People and their relatives were asked to provide feedback about the service and the provider sent out yearly questionnaires to people and relatives to gather their views.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding (published 16 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk and governance at this inspection. We have also made a recommendation about how the service reviews its staffing arrangements and how staff are deployed to ensure people receive care that meets their needs and protect their safety.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 courses were in place. Staff received regular supervision and an annual appraisal.

People were happy with the food served in the home and one person said "We always have nice food." People's nutritional needs were assessed on admission and regularly thereafter. Staff supported people to eat a healthy varied diet. Records to monitor people's nutritional intake were in place where necessary. Staff ensured people had access to health care professionals to maintain their general health and wellbeing.

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 home supported this practice.

Medicines were managed safely by staff who were appropriately trained and had their competency to administer medicines checked regularly. This meant the provider had systems in place to ensure the people who lived at Mount Olivet were safe.

Care plans were personalised focussing on people's assessed needs. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates were in place which reflected that fire inspections, gas safety checks and portable appliance tests (PAT) had taken place.

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.

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.

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 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.