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CQC report explained · a nursing home

What the CQC found at Mount Olivet Nursing Home

Goodpublished 13 March 2025, 18 months ago

Rated Good: inspectors found the home performing well and meeting their expectations.

The latest report, explained

What inspectors found, June 2023

Rated Requires Improvement; inspectors found kind, respectful care, but concerns about risk management, medicines records and quality checks.

This was an unannounced inspection on 5 and 11 April 2023. Inspectors spoke with people living in the home, visitors, staff and health and social care professionals. They also checked care plans, risk assessments, medicines records, recruitment files and quality audits.

The home was rated Requires Improvement overall. Safe and well-led were rated Requires Improvement. Caring was rated Good. Inspectors found that people were treated kindly and with dignity, but records and checks were not always reliable enough to show that risks were being managed safely.

Some repositioning, food and topical medicine records were incomplete. Guidance for people using oxygen was not always detailed enough. The home was also asked to review staffing arrangements because some people and relatives said they sometimes waited for care. The previous overall rating was Outstanding, published in January 2018.

What inspectors praised
  • Kind and respectful care

    People and relatives said staff were kind and caring. Inspectors observed respectful interactions and staff protecting people's privacy.

    “Throughout the inspection we observed staff knocked on people's doors and waited for their answer before entering people's rooms.” from the report
  • People supported to choose

    People were involved in decisions about their care, including what to do, where to sit and what to eat and drink.

    “People were supported to make decisions about their care.” from the report
  • Safeguarding and recruitment

    Staff had safeguarding training and understood how to report abuse. Recruitment checks were completed to help ensure suitable staff were employed.

    “Recruitment processes ensured that, as far as possible, only suitable staff were employed to look after people.” from the report
  • Positive management culture

    The manager was described as approachable and hands-on. Staff said they felt supported, and inspectors found clear lines of responsibility.

    “The registered manager promoted a positive, person-centred culture within the service.” from the report
What inspectors were concerned about
  • Incomplete risk records

    serious

    Repositioning charts were not always completed, including for someone who needed repositioning every two hours. This increased the risk of skin damage.

    “This meant the person was put at increased risk of pressure damage to their skin.” from the report
  • Medicines and oxygen guidance

    serious

    Topical creams were not always recorded as given. Care plans for people using oxygen did not always explain clearly how and when it should be used or adjusted.

    “People did not always receive their medicines as prescribed for them.” from the report
  • Food intake records

    serious

    Food monitoring records were not always completed, so staff could not be sure one person was eating enough. This created a risk of malnutrition and further weight loss.

    “This meant that staff could not be sure that this person was having sufficient to eat which put them at risk of malnutrition and further weight loss.” from the report
  • Quality checks missed problems

    serious

    Audits and provider visits did not identify several concerns found by inspectors. Four pressure-relieving mattresses were not set according to people's weight.

    “Governance systems were not robust or effective enough to monitor and improve the quality and safety of the service provided.” from the report
  • Waiting for care

    needs fixing

    Inspectors saw enough staff during the visits, but some people and relatives said they sometimes waited for care. The home was asked to review staffing and how staff were deployed.

    “Some people told us they sometimes had to wait for care, and they felt the service could do with more staff.” from the report
Questions to ask them, based on this report
  1. 01How do you now check that repositioning records are completed at the required times?
  2. 02How do you make sure topical creams are given and recorded every time?
  3. 03What information is now recorded in care plans for people who use oxygen?
  4. 04How do you monitor food and drink intake when someone is at risk of weight loss?
  5. 05What has changed in staffing levels and staff deployment since the inspection, and how do you respond when people are waiting for care?

The inspection looked at the premises and care provided, but the report gives ratings only for Safe, Caring and Well-led; no ratings are given for Effective or Responsive. This explanation was written from the published report of 27 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.

An earlier report, explained

What inspectors found, January 2018

Rated Outstanding overall; inspectors found exceptionally caring, safe and well-led care, with the other areas rated Good.

Inspectors visited on 13 and 14 November 2017. The first day was unannounced. They spoke with people, relatives, staff and health professionals, observed care, and checked care plans, medicines, staffing, training and safety records.

The home was found to be safe, effective and responsive, all rated Good. Medicines were managed safely, staffing levels were checked, care plans were personalised, and people had access to food, activities and health professionals.

Caring and leadership were rated Outstanding. Inspectors saw kind and respectful staff who knew people well and supported their choices, relationships and interests. They also found strong leadership, good staff support and regular checks on the quality of the home.

The overall rating improved from Good at the previous inspection in October 2015 to Outstanding.

What inspectors praised
  • Kind and personal care

    Staff were compassionate and attentive. They took time to understand people's histories, preferences and ways of communicating.

    “Staff were exceptionally compassionate and proactive in meeting people's wishes.” from the report
  • Strong leadership

    The home had experienced leadership, clear values and a strong focus on improving care. Staff morale was described as exceptionally high.

    “The service was extremely well led by an experienced and exceptionally proactive registered manager.” from the report
  • Personalised support

    Care plans focused on people's strengths, needs and wishes. Staff adapted support when health, communication or mobility needs changed.

    “People's care plans were well organised, person centred and focused on people's strengths and abilities rather than what they were no longer able to do.” from the report
  • Meaningful activities and relationships

    People were supported to enjoy activities, celebrate important events and stay in touch with family and friends.

    “People were supported by staff to have personalised experiences, maintain relationships and build memories with family and friends who were important to them.” from the report
  • Quality monitoring

    The home carried out regular checks covering areas such as medicines, care records, staffing, training and safety. Actions were followed up.

    “There were effective systems to monitor and review the quality of the home.” from the report
What inspectors were concerned about

Inspectors raised no specific concerns in this report.

Questions to ask them, based on this report
  1. 01How will you make sure the current staffing levels continue to meet people's needs as those needs change?
  2. 02How do you record and review changes in a person's health, mobility, nutrition or communication needs?
  3. 03What activities would you offer my relative based on their interests, abilities and wish to spend time in or outside their room?
  4. 04How would you support my relative to communicate choices if they have sight, hearing, speech or other communication difficulties?
  5. 05How would you involve our family in planning and reviewing care, including end of life wishes?

This was a comprehensive inspection of all five areas, carried out over two days, with the first day unannounced. This explanation was written from the published report of 16 January 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.

The story over the years

Every inspection of Mount Olivet Nursing Home

3 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.

  1. June 2023Requires improvementcurrent ratingdown from Outstanding
    Safe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement

    Read what inspectors found at Mount Olivet Nursing Home →

  2. January 2018Outstandingup from Good
    Safe: GoodCaring: OutstandingWell-led: Outstanding

    Read what inspectors found at Mount Olivet Nursing Home →

  3. December 2015Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read this report on cqc.org.uk

  4. September 2014

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  5. March 2014

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  6. December 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  7. March 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  8. January 2011

    Registered with the Care Quality Commission on 7 January 2011.

Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.

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