Apex Care Centre

Apex Care Centre is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

The service had processes in place to ensure people were protected from the risk of abuse. The risks to their individual safety had been assessed and measures were in place to reduce risk. However, people newly admitted to the service did not always come with sufficient information for staff to support them in a safe person-centred way.

Staff told us and records showed there were not always enough staff to support people.

People’s medicines were not always managed safely.

Quality monitoring processes were in place, but some aspects required improvement in relation to medicines and oversight of falls.

The service was clean and there were good infection prevention and control measures in place to reduce the risk to 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’s care was provided in a person-centred way and there was an open and caring culture at the service. Relatives had confidence in the staff to support their family member.

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 good (published 5 December 2020).

Why we inspected

We received concerns in relation to staffing levels, and lack of timely personal care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement in management of staffing levels and quality assurance processes.

The provider had already put measures in place to make improvements to the areas we highlighted.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apex care centre on our website at www.cqc.org.uk.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Apex Care Centre is a residential care home providing personal and nursing care to 31 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

Some staff told us staffing levels were impacted by sickness and absence. The registered manager had not reviewed their staffing calculator for several months. We have made a recommendation regarding the calculation of staffing levels.

Some medicines records required minor improvement. The registered manager took immediate action to address this. Only staff who were appropriately trained administered medicines to people. The provider had a medicines policy and systems were in place to ensure medicines were checked.

People had detailed risk assessments in place to ensure staff supported them safely. Daily records showed staff followed risk assessments.

The provider had systems and processes to ensure people were protected from the risk of infection. The latest government guidance relating to COVID-19 was being followed.

People were protected from abuse. The provider had a policy and staff received training to enable them to recognise and report abuse.

Accidents and incidents were recorded and reviewed.

Audits to check the quality and safety of the service were completed. The registered manager was in the process of implementing an improvement plan for the service so actions from audits were could be added and reviewed every month.

Staff were positive about the support they received from the registered manager.

People living in the service and their relatives were consistently positive about the management of the service.

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 good (published 17 December 2018).

Why we inspected

The inspection was prompted in part due to information regarding risks associated with safeguarding. A decision was made for us to inspect and examine those risks. 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apex Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Apex care Centre 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.

The service is registered to provide accommodation for up to 40 older people or people living with a dementia type illness or a physical disability. The service is made up of five individual units each accommodating eight people. Two of the units provided a secure environment for people living with a dementia type illness. The other units provided accommodation for people with both nursing or residential care needs. There were 38 people living in the service during our inspection. Three people were in hospital.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection of Apex Care Centre in May 2017 we found five breaches of the regulations and the service was rated 'Requires Improvement’. This was because the registered provider failed to notify CQC of issues relating to the safety and welfare of people living in the service, had failed to ensure that people received their medicines in a safe timely and consistent manner, did not ensure that security systems were working in a safe and effective manner, had failed to maintain effective systems and processes to assess, monitor and improve the quality of the service and had not ensured that sufficient numbers of suitably skilled and experienced staff were employed.

Following our last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, “is the service safe” and “is the service well-led” to at least good. On this inspection we found that the provider had ensured that people were kept safe and free from the risk of harm, and that effective systems and processes were maintained to assess, monitor and improve the quality of the service. At this inspection we found that improvements had been made and the service was now rated “Good”.

Systems and processes were in place to keep people secure and safe from the risk of harm and abuse. People had their medicines administered safely by trained and competent staff. The service was clean and staff followed safe infection control practices.

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 service supported this practice. The provider followed the guidance in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had their care needs assessed and their care was planned in line with up to date guidance and legislation. There were enough staff on duty to provide people with care and support. staff were trained appropriately and had the knowledge and skills to carry put their roles. People were provided with a balanced and nutritious diet and had access to a range of healthcare services.

People were cared for by kind, caring and compassionate staff. People and staff had a good relationship and the service had a homely atmosphere. People had their privacy and dignity were respected.

Staff supported people to spend their time as they wished and to maintain their hobbies. People had an advanced care plan to protect their wishes at the end of their life to achieve a comfortable, dignified and pain free death.

People spoke highly of the care they received and the attitude of staff. Staff enjoyed working at the service and were proud of their achievements. The provider had introduced a robust approach to monitoring the quality of the care people receive. The registered manager was respected by people and staff alike.

We carried out our previous unannounced comprehensive inspection at Apex Care Centre on 8 and 9 March 2017. The rating for the service at this inspection was Requires Improvement.

We had found that a number of improvements were needed to ensure people received support which was safe, effective and well-led. This was because the security of the building was not consistently safe, medicines had not always been managed safely and records did not clearly reflect people’s needs and how these were being met. We also found that the registered provider had not completed robust quality checks. This latter shortfall had led to the persistence of the problems noted above and also had contributed to people not receiving consistent and safe care.

This unannounced, focussed inspection was completed on 17 May 2017 to review two of the questions we ask when we carry out our inspection visits; Is the service 'Safe' and is it 'Well-Led.'

We carried out the inspection because we received information from service commissioners about concerns in relation to the service. The concerns related to the safety and well-being of people and about the leadership of the home.

This report covers our findings in relation to the concerning information. You can see what action we have taken at the end of the full version of this report.

There was a registered manager 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.

During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to properly assess and mitigate risks to people, including supporting people to take their medicines safely; staffing levels were insufficient; staff did not always provide people with person-centred care that met their needs and the provider had failed to sustainable establish systems to assess, monitor and keep improving the quality of the service.

We also found one breach of the Care Quality Commission (Registration) Regulations 2009.This was because the provider had failed to notify us of issues relating to the safety and welfare of people living in the home.

Care records were variable in quality and they were not being consistently kept updated to evidence risks identified were being managed and that safe care was always being given.

There were no clear or consistent systems for determining the staffing levels needed based on people’s dependency.

We found there were some improvements in the medicine care records. However, we found there were still some gaps in administration and fridge temperature records and no clear PRN protocols were in place.

Arrangements for the security of the building and the maintenance of the homes call-bell system had not been fully addressed.

The provider had failed to notify CQC of issues relating to the safety and welfare of people living in the home.

There was ineffective communication between the provider, registered manager and senior staff and staff were not consistently supported to receive or act upon good practice guidance.

Arrangements for receiving feedback about and responding to the way the service was being run were ineffective and the provider’s quality assurance and audit systems were not robustly managed.

A culture based on positive team work approaches had not been formed by the provider and registered manager. There was no evidence of clear operational or strategic management planning in place to reliably identify or resolve shortfalls in the way care was delivered. In addition, staff were not supported to receive or act upon good practice guidance. This reduced the registered provider’s ability to ensure that people who lived at the home were kept safe and that people received all of the help they needed.

Apex Care Centre is situated in the seaside resort of Mablethorpe in Lincolnshire. The home can accommodate up to 40 older people with personal and nursing care needs, some of whom live with memory loss associated with conditions such as dementia. The home also provides day care support although this activity is not regulated by the Care Quality Commission (CQC).

There was a registered manager 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.

During our inspection we found some areas in which improvement was needed to ensure people were provided with care that was safe, effective and well-led and that the provider's regulatory responsibilities were being met in full.

This was because the registered provider had not ensured the arrangements for the safety and security of the building were consistently being planned for and maintained. We also found the systems in place to help people to take their medicines did not support the consistent administration of those medicines prescribed for people as required.

People were supported to make decisions for themselves. However, when people needed any additional help to make specific decisions, for example about how care was provided, the information about which decisions had been made and by whom had not been fully reflected in the care records.

In addition the provider had not always notified us of issues relating to the safety and welfare of people living in the home in a timely way.

The provider’s quality assurance and audit systems were not reliably or consistently managed so as to enable them to quickly identify and resolve shortfalls in the services provided for people.

In other areas, the provider was meeting people’s needs in a responsive and caring way.

The provider had recruitment processes in place and background checks had been completed before new staff were appointed to ensure they were safe to work at the home. Staff were supported by the provider and registered manager to access training in order to keep developing their knowledge and skills.

Staff understood how to identify report and manage any concerns related to people’s safety and welfare. Staff knew how to minimise any identified risks and care was supported through staff having access to a range of visiting health and social care professionals when they required both routine and more specialist help.

A range of activities were provided at the home and people were supported to maintain and develop their personal interests and beliefs. People were treated with kindness and compassion by care staff and people had access to the food and drinks they needed to keep them healthy.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of this inspection two people who lived in the home had their freedom restricted in order to keep them safe. A number of other people were awaiting the outcomes of their assessments for a DoLS authorisation. The provider had acted in accordance with DoLS guidance to ensure people had their rights protected.

The provider, registered manager and staff recognised people’s right to privacy, respected confidential information and there were systems in place for handling and resolving formal complaints. When individual concerns or complaints were raised with them the provider and registered manager took action to address them quickly.

People were invited to comment on the quality of the services provided and arrangements were in place for people and their relatives to give regular feedback about the day to day running of the home.