CQC report explained · a nursing home
What the CQC found at Apex Care Centre
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Staffing levels were not always enough to meet people's needs promptly. Medicines were not always managed safely, and new admissions did not always have enough care information.
- Effective?
- Good
- This question was not inspected during this focused visit. The previous comprehensive inspection rating was carried forward.
- Caring?
- Good
- This question was not inspected during this focused visit. The previous comprehensive inspection rating was carried forward, although inspectors found evidence of person-centred and caring practice.
- Responsive?
- Good
- This question was not inspected during this focused visit. The previous comprehensive inspection rating was carried forward.
- Well-led?
- Requires improvement
- Quality checks did not always identify medicines problems, explain action taken after weight loss, or analyse patterns in falls. Several staff had not received regular supervision, and staff shortages affected morale.
What inspectors found, August 2021
Rated Requires Improvement; inspectors found staffing, medicines and oversight problems, although people received kind and person-centred care.
This was an unannounced, focused inspection on 23 June 2021. Inspectors looked only at Safe and Well-led because concerns had been raised about staffing and delayed personal care. They spoke with people, relatives and staff, reviewed care and medicines records, and checked management information.
The home was not always safe. Staff shortages meant people were not always supported promptly. Medicines had not always been managed safely, and new residents did not always arrive with enough information about their care needs. The home was clean and infection control arrangements were judged effective.
The home was not always well-led. Audits did not always identify medicines problems or analyse falls fully. There were also gaps in staff supervision. However, care was person-centred, relatives felt confident in staff, and the manager had started to address some problems.
The overall rating fell from Good at the previous inspection to Requires Improvement. This inspection did not reassess Effective, Caring or Responsive, so their earlier ratings were carried forward.
Kind, personalised care
Care plans were written around people's individual needs. Relatives said staff knew their family members well and provided personalised care.
“People's relatives told us they felt staff knew their family members well and provided personalised care.” from the report
People felt safe
People said they felt safe, and relatives had confidence in the staff and manager. Staff understood safeguarding responsibilities and had up-to-date training.
“People we spoke with felt safe living at the service.” from the report
Clean and good infection control
Inspectors found the home clean and were assured that infection prevention measures, including PPE, testing and visiting arrangements, were in place.
“We were assured that the provider was using PPE effectively and safely.” from the report
Good communication with families
Relatives said the manager and staff were open and honest when things happened. The home also used surveys, newsletters and residents' meetings to involve people.
“All the relatives we spoke with were happy with the way the registered manager and her staff communicated with them when events involving their family member occurred.” from the report
Not enough staff
seriousStaff and records showed that staffing levels were sometimes too low to meet people's needs promptly. Nursing staff were also working very long shifts.
“People were not always supported with enough staff.” from the report
Medicine errors and weak checks
seriousThere had been two serious medicine errors close together. Although the manager investigated them, the medicines audits did not identify the problems or clearly record the action taken.
“People's medicines were not always safely managed.” from the report
Incomplete information for new admissions
needs fixingPeople arriving at the home did not always have enough information about their care needs. Staff sometimes received only about half an hour's notice.
“There were times they felt they were "working blind".” from the report
Quality monitoring needed improvement
needs fixingChecks did not always explain what had been done after weight loss, identify medicine problems or analyse when falls happened. This limited oversight of wider risks.
“There was a lack of analysis of timing of falls to give the registered manager a better oversight of wider risks to people's safety such as lack of staff or changes to routines.” from the report
- 01How many care staff and trained nurses are on duty on each shift now, and what happens when someone is absent?
- 02What changes have been made since the two serious medicines errors, and how are audits now checking that the changes work?
- 03How do you make sure a new resident arrives with complete information about their care and risks?
- 04How are falls reviewed for patterns such as staffing levels or changes to routines?
- 05How often will my relative and their main carers receive care reviews and updates?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and their previous comprehensive ratings were carried forward. This explanation was written from the published report of 20 August 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2020
Rated Good overall; inspectors found effective safety systems and good leadership, but staffing calculations and some medicines records needed improvement.
This was an unannounced inspection on 5 November 2020. Inspectors spoke with people living in the home, relatives, staff and a visiting healthcare professional. They reviewed care records, medicines records, staff files and management records.
The overall rating was Good. The ratings table lists Safe as Good and Well-led as Good. However, the detailed Safe findings say safety had deteriorated to Requires Improvement because staffing levels had not been properly reviewed and some records needed improvement.
The home had detailed risk assessments, trained medicines staff, infection control arrangements and systems for reporting abuse, accidents and incidents. Leadership remained Good, with regular audits, an improvement plan being introduced and positive views from people, relatives and staff.
Risk management
People had clear risk assessments and care plans. Records generally showed that staff followed the guidance, including advice from healthcare professionals.
“People had clear assessments and plans in place to ensure known risks associated with their health were managed.” from the report
Infection control
Inspectors were assured that the home was following guidance on infection prevention, personal protective equipment, testing and outbreaks.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Safeguarding
The home had systems to protect people from abuse, and staff had training on recognising and reporting concerns.
“Records showed staff received training to enable them to recognise and report abuse.” from the report
Leadership
The manager used audits and was introducing an improvement plan. People, relatives and staff were positive about the management.
“People and their relatives were consistently positive about the leadership in the service and the staff team.” from the report
Staffing review
needs fixingStaffing was sometimes affected by sickness, and the system used to calculate staffing needs had not been reviewed for several months. Inspectors recommended reviewing staffing against people's needs and dependency.
“We recommend the provider consider carrying out a review of staffing levels based on the needs and dependency of people using the service.” from the report
Medicines records
needs fixingSome medicines records were not fully clear or accurate, including photographs and instructions for medicines given when needed. The manager provided evidence that these issues had been addressed after the inspection.
“Some minor improvements were required to ensure medicines records were clear and accurate for staff to follow.” from the report
Repositioning records
needs fixingRecords showing repositioning to reduce pressure damage were not always entered in the correct section. The provider later gave information that assured inspectors the issue had been resolved.
“During the inspection the inspector identified an issue where records of repositioning were not always recorded in the correct section of the records.” from the report
People's feedback
minorThe manager had surveyed staff but had not yet sent surveys to people and relatives. There was a plan to obtain their views.
“The registered manager had not sent surveys out to people and relatives but had a plan to ensure their views would be obtained.” from the report
- 01How have you reviewed staffing levels against the needs and dependency of people living here?
- 02What happens when staff are absent through sickness, and how do you decide whether replacement staff are needed?
- 03How do you check that medicines records, including as-needed medicine instructions and photographs, remain accurate?
- 04How do you make sure repositioning records are entered in the correct place and checked promptly?
- 05When will people and relatives be asked for their views through the planned surveys?
This was a focused inspection prompted partly by safeguarding information and covering Safe and Well-led; the other key questions were not inspected in this report. This explanation was written from the published report of 5 December 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Apex Care Centre
6 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- August 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2020Goodstayed GoodSafe: GoodWell-led: Good
- December 2018Goodup from Requires improvementSafe: GoodWell-led: Good
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2015
Registered with the Care Quality Commission on 5 October 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.