This inspection took place on the 3 December 2018 and was unannounced.

We inspected this service in July 2017 and found the provider was in breach of the Health and Social Care Act2008 (Regulated Activities) Regulations 2014 and Registration Regulations 2009. The provider had not ensured people received safe care and treatment; records were not up to date and people had not received personalised care and support and the quality assurance system had not been effective as it had not identified areas where improvements were needed. The overall rating was inadequate and the service was put in ‘special measures’.

At the last inspection in February 2018 we found improvements had been made and the provider had met the legal requirements. However, some areas needed further improvement and time to ensure they were part of everyday practise at the home. The overall rating for the service was Requires Improvement.

At this inspection we found the improvements had not been sustained and there were breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The quality assurance system had not been effective as it has not identified areas where improvements were needed. For example, medicines were not managed safely and people had not consistently received their medicines as prescribed by medical practitioners. Care plans had not reflected people’s individual assessed needs and there was no clear guidance for staff to follow to provide personalised care and support.

Risk had been identified and systems were in place to reduce these, but the provider had not ensured these were followed and risk was reduced as much as possible. Accident and incidents had been recorded. However, the provider had not investigated the causes or implemented changes, which meant lessons had not been learnt and plans had not been put in place to prevent a re-occurrence.

This is the fourth comprehensive inspection where improvements were needed under the key questions safe, responsive and well led and the overall rating remains Requires Improvement.

Bexhill Care Centre 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.

The home is registered to provide nursing and personal care and accommodation for up to 41 older people. At the time of the inspection there were 24 people living in the home. 22 people in Poppy unit and two people in Lavender unit. Some people were living with dementia and needed support with personal care and others had more complex needs, which required nursing care.

The service did not have a registered manager. A manager had been appointed six weeks prior to this inspection and they said they were completing their application to register with CQC as the registered manager. 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.

At this inspection we rated the service ‘Requires Improvement’. We found improvements were needed to ensure there was an adequate process for assessing and monitoring the quality of the services provided and to ensure that records were accurate and complete. The provider has been rated ‘Requires Improvement’ four times and we have determined they are not meeting the regulation in relation to Governance because of this.

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. Staff knew people well and were kind and caring as they assisted people

We inspected Bexhill Care Centre on the 12 and 13 February 2018. The inspection was unannounced.

We previously carried out an inspection of this service in December 2015 when we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Health and Social Care Act (Registration Regulations 2009). We found the provider had not safeguarded people from abuse, safe care and treatment was not provided, there were not enough staff employed in the home, people’s personal records were not complete and up to date and the quality assurance and monitoring systems were not effective. The provider had also failed to inform CQC about incidents that affect the provision of services, such as insufficient staff. We received information of concern about staffing levels and carried out a focused inspection in February 2016. We found improvements had not been made and we took enforcement action.

The inspection in December 2016 found improvements had been made and the provider had met the regulations.

At the last inspection on 17, 19 and 21July 2017 the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Registration Regulations 2009. We found the service was not consistently safe because there were not enough staff with the skills and expertise to provide safe care and treatment. Risk had not been assessed appropriately, which put people at risk of harm or injury. Medicines were not managed safely. Emergency systems were not effective and safeguarding procedures had not been followed, which put people at risk of improper treatment. Personal records were not up to date and personalised care was not consistently provided. The quality assurance system was not effective and had not identified areas for improvement and CQC had not been informed of these concerns. The overall rating was inadequate and the service was put in ‘special measures’.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm that the service now met legal requirements. We found improvements had been made and the provider had met the legal requirements. However, we identified some areas needed further improvement and others needed time to be embedded into day to day practice.

Bexhill Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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. The home is registered to provide nursing, personal care and accommodation for up to 41people. There were 21 people living at Bexhill Care Centre at the time of the inspection. Some people had complex needs and required nursing care and support. Others were living with dementia or had physical disabilities and needed assistance with personal care and moving around the home safely.

The registered manager was present during the inspection. 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.

Since the last inspection there had been significant changes. The provider has taken a more active role in overviewing the service and had become the nominated individual. A nominated individual (NI) is the responsible person within the organisation. A registered manager had been appointed and an external consultant provided guidance. The NI, registered manager and consultant worked together to review the provision of services at the home. The quality assurance system had been reviewed and a plan introduced to ensure all areas of the service were audited regularly by senior staff resp

Bexhill Care Centre is located on the main road between Eastbourne and Bexhill. The original building has been extended and consists of two units with their own communal areas, with lifts to enable people to access all parts of the home. There are secure gardens to the front and rear which are accessible to people who use wheelchairs or who require assistance with their mobility.

The home has accommodation for up to 41 people with nursing and personal care needs. There were 25 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others were living with dementia and because of physical frailty or medical conditions needed assistance with person care and moving around the home safely.

This inspection took place on the 17, 19 and 21 July 2017 and was unannounced.

The service had not had a registered manager since November 2016. The provider told us the last manager had recently left the service and they were interviewing prospective managers at the time of the inspection. 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.

At our comprehensive inspection in December 2015 we found the provider was not meeting the regulations with regard to safeguarding people from abuse and improper treatment, safe care and treatment, staffing, personal records and assessing and monitoring of the services provided. We received information of concern about staffing levels and carried a focused inspection in February 2016. We found improvements had not been made and we took enforcement action.

At our last inspection in December 2016 we found improvements had been made and the provider had met the regulations. After that inspection we received new information of concern in relation to the management of the home and staffing, which may impact on people’s care and safety. As a result we carried out a comprehensive inspection on 17, 19 and 21 July 2017 and found the provider was not meeting the legal requirements with regard to safeguarding people from abuse, safe care and treatment, staffing, personalised care, personal records and assessing and monitoring the services. There were five repeated breaches of these regulations and one new breach and there were other areas where improvements were needed

The quality assurance and monitoring system had been reviewed and a number of audits had been completed. However, the system had not identified areas of concern that we found during this inspection and appropriate action had not been taken to ensure people’s safety.

Safeguarding referrals had not been made to the local authority when staff were aware of concerns about people’s safety. Although staff had attended training, they understood about abuse and explained what action they should take if they knew people were at risk of harm.

The management of medicines was not safe. Nurses employed at the home had not accepted responsibility for the ordering, receiving, checking and giving out medicines, which meant people were at risk of not receiving their prescribed medicine.

There were not enough permanent staff working in the home, staff allocation was not based on people’s needs and there was a risk that people would not receive the support and care they needed. Staff said they had completed relevant training. Although there were no records to verify this staff demonstrated an understanding of people’s needs and how they would meet them. One of the staff said they had had one to one supervision and, however this was not up to date and it was not clear how this would continue with the recent changes in management.

Assessments had been completed to identify

Bexhill Care Centre is located on the main road between Eastbourne and Bexhill with parking on site. The original building has been extended, made up of two units with communal areas and lifts to enable people to access all parts of the home. There are gardens to the front and rear which are accessible.

The home has accommodation for up to 41 people with nursing and personal care needs. There were 16 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions, and some were living with dementia.

A registered manager had not been in place since October 2016. A manager had been appointed and was applying to register at the time of the inspection. 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.’

This inspection took place on the 21 and 29 December 2016 and was unannounced.

At our inspection on 17 and 21December 2015 we found the provider was not meeting the regulations with regard to safeguarding service users from abuse and improper treatment, safe care and treatment, staffing, personal records and quality assessment and monitoring of the services provided. At this inspection we found improvements had been made and the provider had met the regulations.

Because of additional concerns we carried out a focused inspection on 5 February 2016 and looked specifically at the safe question We found the provider was not meeting the legal requirements in relation to safe care and treatment. We took appropriate action. At this inspection we found improvements had been made and the provider had met the warning notice.

We found that additional work was needed to ensure the improvements were embedded into practice. For example, the quality assurance and monitoring system had been reviewed and a number of audits had been completed. However, the system had not identified areas of concern that we found during the inspection. Such as gaps in the care plans and risk assessments.

There were systems in place for the management of medicines and we observed staff completing records as they administered medicines but, the guidance for staff to give out some medicines, such as those prescribed ‘as required’, was not clear.

Staff had attended safeguarding training and they demonstrated an understanding of abuse and said they would talk to the management if they had any concerns. They knew that referrals were made to the local authority and how to make these. People said they were comfortable and relatives felt people were safe living at Bexhill Care Centre.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had access to healthcare professionals, including the GP, optician and chiropodist. Choices were available for meals; people were supported to have a healthy diet and, they were consulted about the menu. Relative and friends could visit at any time and they were made to feel very welcome.

The atmosphere in the home was calm and relaxed. Conversations between people, visitors and staff were friendly and staff respected people’s choices and protected their dignity when providing personal care.

Complaints procedures were in place and any concerns had been addressed following the providers procedures. The provider and manager encouraged people, relatives and staff to be in

Bexhill Care Centre is located on the main road between Eastbourne and Bexhill with parking on site. The original building has been extended, made up of two units with communal areas and lifts to enable people to access all parts of the home. There are gardens to the front and rear which are wheelchair accessible.

The home has accommodation for up to 41 people with nursing and personal care needs. There were 16 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions, and some were living with dementia.

A registered manager had not been in place since September 2015. A manager had been appointed and had applied to register at the time of the inspection. 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.’

This inspection took place on the 5 February 2016 and was unannounced.

People were supported to make choices about the support and care they received and staff were kind and respectful. However, there were not enough staff with the appropriate experience and skills to meet people’s individual needs. This meant that people were not being helped by staff who knew how to assist them to move safely or protect them from harm.

The information in care plans was limited; risk had not been assessed for some people and, there was no clear guidance for staff to follow to support people.

Systems were not in place to monitor the support and care provided and, staff were not clear about their individual responsibilities or accountability for their actions.

The atmosphere in the home was relaxed and comfortable and a relative and visitor felt people were safe and well cared for.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Bexhill Care Centre is located on the main road between Eastbourne and Bexhill with parking on site. The original building has been extended, made up of two units with communal areas and lifts to enable people to access all parts of the home. There are gardens to the front and rear which are accessible.

The home has accommodation for up to 41 people with nursing and personal care needs. There were 19 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions, and some were living with dementia.

A registered manager had not been in place since September 2015. A manager had been appointed and was applying to register at the time of the inspection. 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.’

This inspection took place on the 17 and 21 December 2015 and was unannounced.

People were supported to make choices about the support and care they received and staff were kind and respectful. However, because of staff sickness and the use of agency staff people were not confident that staff had a good understanding of their needs and were unable to provide the care they needed without being directed by the people they supported. There were not enough staff with the appropriate experience and skills to meet people’s individual needs.

The information in care plans was limited; risk had not been assessed for some people and, there was no clear guidance for staff to follow to support people. The quality assurance and monitoring system was not robust and had not identified the shortfalls we found during this inspection, including staffing, care plans and record keeping.

People had access to healthcare professionals, including the GP, optician and chiropodist. Choices were available for meals and people were consulted about the menu. Relatives and friends could visit at any time and they were made to feel very welcome.

There was a calm, relaxed atmosphere in the home and communication between people, visitors and staff was friendly and open. People said they could talk to the staff and the manager and provider were available if they wanted to discuss anything. Concerns had been addressed promptly.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Health and Social Care Act 2008 (Registration Regulations 2009). You can see what action we told the provider to take at the back of the full version of this report.