Montana Residential Home provides accommodation and personal care for up to 19 older people some of whom may be living with dementia. At the time of our inspection there were 16 people using the service. The service is set over one floor and is situated in the village of Great Barton on the edge of the town of Bury St Edmunds in Suffolk.

Montana Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This comprehensive inspection took place on 18 May 2018 and was unannounced. The provider, Grace and Compassion Benedictines, is a Catholic organisation and the home is connected to a convent however all are welcomed regardless of their faith or background. The staff team was made up of Nuns (Sisters with the Grace and Compassion Benedictine) and 'lay' staff. When we refer to care staff in the report we are referring to both the Nuns and the care staff.

At our last comprehensive inspection in July 2015 we rated the home as Outstanding in the key question of caring and Good in the four other questions that we ask. In line with our methodology we rated the home as Good overall. At this inspection we found that the home had developed further. We have rated the service Outstanding in caring, responsive and well-led making the overall rating for the service Outstanding.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC 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 was highly visible and approachable and enabled and empowered staff to deliver high quality care and to seek advice from her if needed. The registered manager had excellent knowledge of the home and the people living there in order to ensure that people had their preferences met. Staff enjoyed working at the home and spoke positively about the registered manager and their strong leadership style and their oversight of the home. Staff displayed they delivered exceptional care, compassion and empathy that showed all people mattered and were important. People who used the service commended the outstanding quality of care they received.

People received exceptionally personalised care and support which they were in control of. Activities were planned by staff and volunteers who worked closely with people to establish their individual and unique preferences. There was an exceptionally strong ethos within the home of treating people as individuals and with respect. People were at the forefront of their care. Information was given to people about how to raise any concerns they may have and where concerns were raised these were dealt with speedily and in detail. People's individual religious and spiritual needs were recognised and met. The care people received at the end of their lives was exemplary. Staff were passionate about providing the best, most compassionate and respectful end of life care to people and demonstrated that all people who lived and died at the home mattered and were important

People's medicines were managed safely and people received their medicines as prescribed. People received support and treatment from health professionals when needed.

There were sufficient staff to meet people’s needs in a timely and responsive manner. Staff were provided with regular training and were supported by their colleagues and the registered manager to do their jobs effectively. Staff were provided with effective support when they started work at the home. New staff received an induction to the home and training that gave them the kno

The inspection took place on 24 July 2015 and was unannounced. The service was last inspected in October 2013.

The service provides accommodation for 19 older people some of whom may be living with dementia. At the time of our inspection 14 people were living at the service and two people were in hospital. The service provides ground floor accommodation for people of any faith or no faith. The staff team includes Catholic sisters who live onsite and care staff who do not.

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.

Everybody we spoke with in connection with the inspection of this service commended the caring and professional way care and support is provided. People who used the service and their relatives, were very keen to tell us how pleased they were to have found the service. All the staff we spoke with told us they would happily place a relative at the service.

Staff were trained in keeping people safe from abuse and understood their responsibilities should they suspect abuse had occurred. Staff were able to outline how they would report any concerns they had both within the organisation and externally.

There were sufficient numbers of staff on duty to meet people’s needs. People were confident that their needs would be met quickly and this is what we noted during our inspection.

Risks to people’s health and wellbeing were assessed and reduced as much as possible but there was a strong commitment to ensuring that people continued to take part in activities which were important to them and to try new things. Risks associated with this were assessed. The service maintained a good balance between keeping people safe and enabling them to maintain their independence and play a meaningful part in the life of the service.

Medicines were well managed and people received the medicines they needed safely. People were supported to take their medicines themselves and remain independent if this was their wish.

Staff received the induction and training they needed to carry out their roles effectively. Staff demonstrated a good knowledge of the people they were supporting and caring for and knew people’s particular preferences and wishes with regard to their care.

We saw that staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards DoLS) and the service acted in accordance with them. The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People who used the service were very positive about the food and were able to exercise choice about their meals. Mealtimes were seen to be very sociable occasions which people greatly enjoyed. People identified as being at risk of not eating enough were promptly referred to the dietician and monitored to ensure no further unplanned weight loss. Support around people’s nutrition was managed discretely and sensitively.

People were supported to access healthcare professionals when they needed them. Healthcare needs were met promptly and staff were encouraged to increase their knowledge of people’s health conditions through training and a large library of DVDs and reading materials in the main office.

Staff were caring and committed and we saw that people were treated respectfully and their dignity was maintained. The main thing people who used the service, and their relatives, wished to stress to us was how very caring this service is. The atmosphere was of a friendly and happy place and the good relationships between staff, the people they were supporting and visiting relatives were observed throughout the service. The staff worked collaboratively and all were seen as playing an important part in providing the best possible service.

People were involved in assessing and planning all aspects of their care and we saw that care plans had been signed by them to reflect their involvement . People’s care was regularly reviewed with their keyworker and the manager demonstrated that they had an in depth knowledge of people’s care needs.

People were supported to follow a wide range of interests and hobbies and were involved with the local community. People who did not wish to take part in any structured activities had their wishes respected. People were given meaningful tasks to carry out related to the running of the service such as helping with recruitment and organising resident meetings. This meant a lot to people. The atmosphere was often described to us as being homely and like a family. There was no sense of hierarchy and staff and residents had formed meaningful friendships. People were not seen as simply being cared for but as being part of a small community.

There had been no formal complaints since our last inspection but we saw concerns raised informally were managed promptly and well and to people’s satisfaction. People who used the service, and their relatives, felt they were actively involved in developing the service and were encouraged to give feedback in a number of ways.

Staff understood their roles and were well supported by the management team and were encouraged to develop their skills further. People were very positive about the registered manager and praised the open culture of the service.

The service had received recognition in the form of awards and commendations for aspects of the service. The manager was focussed on the continuous improvement of the service . They attended workshops and local groups to develop their skills and increase their knowledge of developments in the care sector which they then cascaded to staff. Staff were also keen to increase their knowledge and skills in order to provide the best service

We found that the service provided safe care to people who used the service. The care was delivered in an effective manner that met the needs of those people who used it. We found that people were protected from the risks of an unsafe environment because the service had effective methods that monitored the health and safety of the buildings and an effective maintenance programme in place.

We spoke to four people who used the service and each person said they felt happy, safe and well cared for. One person told us “All the staff are respectful and care for me in a kind way.”

We found that staff were suitably trained and supported by an effective style of leadership which was responsive to the needs of the people who used the service. We also found that there was an appropriate and effective system in place to manage complaints.

We spoke with five people using the service. They all told us that they were happy with the support they received and that they felt safe. One person explained, "I came here from another service where I felt cut off and alone. It is completely different here because the Sisters have time to chat with me and I think that they genuinely care. I am treated very well and have no worries." Another person told us, "Staff here are outstanding. They have gone out of their way to help me and to give me the right care. I feel safe when the hoist is used. I know that I can trust the Sisters." We also found that family members were happy with the service provided. One relative said, "I am very happy with the care here. The Nuns of the Benedictine Order show exemplary commitment and compassion."

We found that the service was meeting the personal, emotional and healthcare needs of people using the service. Staff were well trained and we saw evidence that they were competent in supporting people to maintain their independence and to stay safe. We received feedback from people using the service and their relatives which confirmed that staff respected people's individual preferences. Feedback was regularly sought from people using the service, their families and visiting healthcare professionals and this information was used to improve the way that support was delivered. Steps had been taken to ensure that environment and equipment were serviced and safe.

We had the opportunity to talk with almost all of the people who lived in the Montana Residential Home, all of the people we spoke with were very happy living in the home and with the care they received. They told us that they had enough to eat and drink and that the quality of the food with was very good.

People were complimentary about the nuns who carried out the majority of the duties and said that the home met all their needs.