This inspection took place on 19 December 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Jack Dormand Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Jack Dormand Care Home accommodates 43 people in one adapted building across two floors. On the day of our inspection there were 43 people using the service. Some of the people had nursing care needs and some people were living with a dementia type illness.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in October 2015 and rated the service as ‘Good.’ At this inspection we found the service had improved to ‘Outstanding’ and met all the fundamental standards we inspected against.

Without exception, people who used the service and family members told us staff were caring. We observed and heard many examples of the caring and fun nature of staff and saw how staff had gone the “extra mile” to provide outstanding care.

The registered manager had identified innovative ways of improving the social and communication skills of a person with social anxiety disorder. Staff had identified people with communication needs or who required additional social stimulation. They took the time to visit people in their rooms and engage in activities or conversations of the person’s choice.

Staff were sensitive to times when people needed caring and compassionate support, and anticipated people’s needs and recognised distress and discomfort at the earliest stage.

Staff helped people express their views and people’s preferences were clearly documented in their care records. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

The service was extremely person-centred. Person-centred means the person was at the centre of any care or support plans and their individual wishes, needs and choices were taken into account. People received personalised care that was responsive to their needs.

One of the nurses at the home was the provider’s current nurse of the year and had been put forward for the National Care Awards, where they won the national nurse of the year award. This was in recognition of the nurse’s “outstanding clinical and managerial qualities” and “high level of dedication”.

The provider had innovative ways of protecting people from social isolation, and went the extra mile for people they supported and to find out about their past.

The service provided outstanding end of life care to ensure people’s end of life was as comfortable, dignified and pain free as possible.

People and family members were an integral part of the service and the provider had innovative ways of involving them. For example, in making improvements to the home.

The registered manager continually strived to develop their knowledge and skills, and shared this learning with staff to ensure continuous improvement across the staff team.

The registered manager worked in partnership with external professionals to develop and improve outcomes for people who used the service, and the service had excellent links with the local community.

The service had a positive culture that was very person-centred and inclusive. Staff were visibly proud to work at the home. Awards were presented to staff to recognise and celebrate the efforts they had made and the impact they had upon the lives of people, their families and other s

Due to the nature of this follow up inspection we did not seek the views of people using the service. We found appropriate background checks were undertaken before staff supplied by employment organisations / agencies were able to work in the home.

We found care and treatment was planned and delivered in a way which ensured people’s safety and welfare. One person who lived at the home told us, “Anyone coming in needn't feel frightened. The staff are friendly and that’s one of the big things about here.” Another person said, “They treat us really well.” One visitor told us, “The staff are nice, good lasses. You can’t fault them. They bring me cups of tea and I can have lunch here if I want to.”

We found the provider had made suitable arrangements to manage peoples’ medicines safely. A visitor told us, “They make sure people take their medicines.”

The provider had not taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people. This was because they had not always completed thorough background checks of staff supplied by nurses agencies.

We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and promote their health and wellbeing.

We also found the provider had taken steps to listen to and act upon peoples complaints.

Some people, because of their dementia care needs, were unable to tell us their views. Therefore, we spent time observing care practice where people with dementia were accommodated. We saw people were treated with dignity and respect. For example, when staff talked with people they made sure they got down to their eye level. When people were supported to walk, they were not rushed but supported to move at a pace comfortable for them. We heard staff address people respectfully, speaking quietly about private matters.

Overall we found significant improvements had been made since we last visited in April 2012.

People told us that the staff had asked them about their care needs before they moved into the home. People told us they could choose how to spend their day. They told us “We can get up and go to bed what time we like.” However, we found that people with dementia care needs were not supported to make choices.

A relative told us “I was given leaflets about the home.” However, we found that some people were not given the same information about the service.

Some people, because of their dementia care needs, were not able to tell us what they thought about living in the home. We watched how the staff supported the people in their care. We saw people were not always treated with dignity and respect. For example, when talking to people staff used phrases like “Open your mouth” and “Sit down, your dinner is getting cold.” However, not all staff approached people in their care in this way. We did see some positive interactions.

We talked to some visiting relatives about the care their family member received. Everyone was complimentary about the care provided.

People living in the home told us:

“The staff couldn’t be better.”

“They check we have had a bath and they let you do what you want” and

“They notice if you need help.”

However, we found that information in the care plans was not always up-to-date. Also staff did not always follow what was in the care plans and therefore put people’s care and welfare at risk.

Relatives told us they would have no hesitation in making a complaint and had confidence that things would be put right. Similarly service users said “We have no complaints. I love it here.” However, we found that people were not protected against the risk of abuse because the provider had not taken reasonable steps to prevent it from happening.

One person took time to show us their bedroom. They said they had a lovely room and were very happy with it. However, a relative commented that the home environment could “do with some work.”

People living on the ground floor of the home told us “There are plenty of staff around if you need them.” However, we found that people with dementia, living on the first floor of the home, and assessed as being at high risk of falling, were regularly left unsupervised at lunchtime and therefore at risk.

This inspection took place on 28 and 29 October 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting. The home had a registered manager in place. 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.

Jack Dormand Care Home was last inspected by CQC on 4 February 2014 and was compliant with the regulations in force at the time.

Jack Dormand Care Home is a purpose built, two storey, care home situated in the village of Horden, County Durham. The home provides general nursing, residential, respite and palliative care for up to 43 older people and people with a dementia type illness. On the day of our inspection there were 40 people using the service. The home comprised of 43 bedrooms, none of which were en-suite. The home was set in its own grounds and facilities included several lounges, dining rooms, communal bathrooms and toilets, a smoking room and two hairdressing rooms.

People who used the service and their relatives were complimentary about the standard of care at Jack Dormand Care Home. Without exception, everyone we spoke with told us they were happy with the care they were receiving and described staff as very kind, respectful and caring.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Training records were up to date and staff received supervisions and appraisals.

There were appropriate security measures in place to ensure the safety of the people who used the service and the provider had procedures in place for managing the maintenance of the premises.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and was suitably designed for people with dementia type conditions.

The service was working within the principles of the Mental Capacity Act 2005 and any conditions on authorisations to deprive a person of their liberty were being met.

We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. Care records contained evidence of consent.

People were protected against the risks associated with the unsafe use and management of medicines.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required.

The home had a full programme of activities in place for people who used the service.

All the care records we looked at showed people’s needs were assessed. Care plans and risk assessments were in place when required and daily records were up to date. Care plans were written in a person centred way and were reviewed regularly.

We saw staff used a range of assessment tools and kept clear records about how care was to be delivered. People who used the service had access to healthcare services and received ongoing healthcare support.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.