We undertook a comprehensive inspection on 15 and 16 August 2018. The inspection was unannounced.

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 enjoye

Apex Care Centre is situated in the seaside resort of Mablethorpe in Lincolnshire. The home can accommodate up to 40 adults and 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).

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 ha

We carried out an unannounced inspection at Apex Care Centre on 8 and 9 March 2017.

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

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 experience 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 were 20 people living at the home at the time of our inspection.

The home originally opened in May 2015. It was re-registered with us by the same registered provider as a limited company in October 2015. This was our first comprehensive inspection since the home was registered on 5 October 2015. We carried out this unannounced inspection on 1 December 2015.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

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 our inspection the registered manager confirmed they had not needed to submit any DoLS applications for people living in the home but understood the processes required to do this if needed.

People said they felt safe living at the home and that their needs were met. People also said were treated with respect and their dignity was maintained. Arrangements were in place to support people to enjoy a range of activities and further develop their individual interests.

Staff knew how to recognise and escalate any concerns related to people’s safety and there were sufficient staff employed at the home to enable staff to care for people safely. However, the recruitment reference checks undertaken before staff commenced in post had not always been fully completed in advance of new staff commencing work. The provider was taking appropriate action to address this issue.

People had to access appropriate healthcare services and their medicines were managed safely. Menu planning took account of people’s nutritional needs and they were provided with a variety of food and drinks which matched their preferences and kept them healthy.

The provider, registered manager and staff listened to people and information was available to support people to raise concerns or make a formal complaint if this was needed.

Systems were in place to regularly assess and monitor the quality of the services people received.