This inspection took place on 14 and 16 August 2018 and was unannounced.

Elsinor Residential Home is registered to provide residential care for up to 35 older people who may also be living with dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

Accommodation is provided in an adapted town house spread across five floors. There is lift access between the floors. At the time of our inspection, there were 25 older people and people living with dementia using the service.

At the last inspection in December 2017, we rated the service inadequate overall and identified five breaches of regulation. This included breaches of the fundamental standards of quality and safety relating to person-centred care, the need for consent, safe care and treatment, staffing and the governance of the service.

At this inspection, significant improvements had been made and the service was compliant with the regulations relating to the need for consent, safe care and treatment, person-centred care and staffing. However, there were a number of ongoing issues that had not yet been addressed and further sustained improvements were needed. There was a new breach of regulation relating to recruiting fit and proper persons and a continued breach of regulation relating to the governance of the service.

The service did not have a registered manager. A registered manager is a person who has registered with the 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. The last registered manager left the service following our last inspection. A new manager was in post and had been managing the service since December 2017. They were planning to apply to become the registered manager, but had not completed this process.

Further improvements were needed to some of the arrangements for managing medicines to keep people safe. There were still some gaps in staff’s training. Supervisions that had been completed were good, but not all staff had received a supervision and these were not yet documented at the frequency set out in the provider’s new policy and procedure.

The provider did not have a robust recruitment process. Some records were not always well maintained. For example, mental capacity assessments and best interest decisions had not been documented in line with relevant legislation and best practice guidance. We spoke with the manager about reviewing and ‘signing off’ accidents and incidents and keeping more detailed records of the support provided with activities.

The provider’s audits did not evidence a sufficiently robust approach to monitoring and supporting improvements.

There were two breaches of regulation relating to fit and proper persons employed and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

Staffing levels had improved and sufficient staff were deployed to meet people’s needs. The manager monitored staffing levels to make sure they were safe.

The manager had made appropriate applications to deprive people of their liberty in line with the requirements of the Mental Capacity Act 2005.

People told us they felt safe living at the service. Staff were trained to recognise and respond to safeguarding concerns.

Action had been taken to improve fire safety within the home. We spoke with the manager about exploring risks relating to people falling down the stairs or falling from height because of single paned glass in some of the windows. They made arrangements to install safety film on single paned glass and keypads to res

Elsinor Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 service accommodates up to 35 people in one adapted building and primarily caters for older people, some of whom may be living with dementia. The service does not provide nursing care.

The inspection took place on the 16 November, 4 and 22 December 2017. The first day of inspection was unannounced; the second and third days were announced. At the time of our inspection, 28 older people were using the service and a registered manager was in post. A registered manager is a person who has registered with the 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.

At the last comprehensive inspection in January 2016, we rated the service ‘Good’, but asked the provider to take action to make improvements as the environment was not suitable for people living with dementia. We completed a focussed inspection in January 2017 and found this action had been completed.

At this inspection, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the first day of our inspection, we communicated our concerns urgently with the provider who began taking action to make sure people who used the service would be safe.

After the second day of inspection, the registered manager left the service. A manager from another service owned by the provider took over this responsibility and informed us they planned to register with the CQC to manage Elsinor Residential Home. Therefore they were responsible for the service at our visit on 22 December 2017. We have referred to them as ‘manager’ throughout the report.

Insufficient numbers of staff were deployed throughout the service and staffing levels impacted on the quality of the experience people received within the service. The provider had not regularly reviewed staffing levels to make sure they were sufficient to respond to people’s needs. This was discussed with the manager who immediately began to recruit three more care staff positions and a waking night staff position to the service. Staff deployment throughout the service was also being reconsidered by the manager.

Robust systems and process were not in place to ensure the safety of people who used the service in the event of a fire. Fire drills had not been completed to simulate the night time staffing levels and ensure the procedure would work during the night time. This was immediately rectified with all staff attending drills and evacuation practises.

The provider had not assessed or properly managed environmental risks. Environmental risk assessments had not been completed and deficits within the service had not been identified and rectified by the provider. For example we found fire doors had not been fitted where required and window opening restrictors were not consistently in place to minimise the risk of falls from height. This put people at risk of avoidable harm.

Medicine management was not safe. We identified numerous examples where staff had failed to administer people’s prescribed medicines. This placed people who used the service at increased risk of harm. People's medicine administration records (MARs) were inaccurate and not u

We carried out an unannounced comprehensive inspection of this service on 20 January 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 15 Health and Social Care Act 2008 (Regulated Activities) 2014 Premises and equipment.

We undertook this focused inspection on 5 January 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Elsinor Residential Home) on our website at www.cqc.org.uk.

Elsinor Residential Home is a care home providing accommodation and personal care for up to 35 older people living with dementia. There was a registered manager employed at the service. 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 the comprehensive inspection in January 2016 we found the environment was not dementia friendly and did not therefore meet the needs of the client group who were all living with dementia. When we returned we found that improvements to the environment had been made. These included use of contrasting colours to highlight important areas such as toilets and more effective signage using pictures and words to help people find their way around.

There were plans in place to change all the patterned carpets in the service over time. Patterned carpets can cause confusion if you have dementia, as it becomes increasingly difficult to distinguish between design and actual objects. We saw people's pictures and name on their bedroom doors making it easier for people to identify their room.

The registered manager was using current good practice guidance to identify where further improvements could be made to enhance people's well-being.

This meant that the previous breach of Regulation 15 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This inspection took place on 20 January 2016 and was unannounced. At our last inspection of the service we found no breaches of regulations.

Elsinor is registered to offer care and accommodation for up to a maximum of thirty five people. The home offers care for older people who are living with dementia. Dementia is an umbrella term used to describe the range of conditions that cause changes in memory and other cognitive abilities that are severe enough to interfere with daily life The service does not offer nursing care.There were 31 people resident on the day we inspected.

There was a registered manager employed at this service who has been in post for 20 years. 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.

The service was not consistently effective. The provider had not taken account of current good practice to make the environment dementia friendly. You can see what action we told the provider to take at the back of the full version of the report.

The staff were working within the principles of the Mental Capacity Act 2005. We saw staff give people choices and allow them to make their own decisions.

People’s needs were assessed by staff before they went to live at the service. This information was used to develop peoples care plans.

The service provided a range of activities for people but there was a need for more meaningful activity to support people living with dementia.

No recent complaints had been received at the service but people knew who to speak to if they wished to raise concerns.

People were provided with a choice of food and drink at mealtimes. People at risk of weight loss had been referred to their GP and the appropriate health professionals

Staff undertook training to learn new skills and keep them up to date. They had been trained in safeguarding adults and could describe the signs of potential abuse.

Risk assessments were undertaken to determine the risks present for people and action was taken to help minimise those risks. People had personal individual evacuation plans in their care records to assist staff in the event of a fire. Fire safety equipment was properly maintained.

Staff had been recruited safely and there were sufficient staff on duty to meet people’s needs. Checks of staff’s previous employment history had been carried out prior to them working at the service.

Medicines were managed safely. Senior care workers administered medicines and audits were completed.

Staff treated people with kindness and spoke respectfully to them. It was clear that they knew people well.

People were well supported at the end of their life. Staff worked with the care homes team from the local hospice to ensure people received good care.

During our inspection on the 22 January 2014 we used a number of different methods to help us understand the experiences of people who used the service. Some of the people using the service had a memory impairment which meant they were not always able to tell us about their experiences. We carried out a short observational framework inspection. We spent some time observing daily life within the home, and we spoke with two people whose relatives used the service and two social care professionals.

People who used the service told us that the staff were friendly and “Very nice”. They said that staff took time with them and helped them when they needed it. We observed positive interactions between staff and people using the service. Staff treated them with respect.

People told us they enjoyed the meals provided and staff told us they recorded what people had drank and eaten so they could monitor their dietary intake.

Elsinor was well maintained and health and safety checks on equipment used in the home was carried out at suitable intervals.

Staff told us that the manager was very supportive and they had received training to help them carry out their job. They told us they had regular supervision and an annual appraisal to ensure their skills remained up to date. We spoke with two social care professionals. They told us that the staff worked very well within the home and asked for advice when they needed it.

We saw the complaints procedure and noted there had been no complaints in the last 12 months. The manager told us they dealt with minor issues on a daily basis.

We spoke with two relatives who visited the home on the day of the inspection visit. We made observations of care and found that staff were attentive and responsive to people's needs. Both visitors were complimentary about staff and told us they were approachable and kind. One person told us "They tell me if anything has happened that I need to know. I feel (my relative) is safe here."

We found that people were consulted about their care and that the home sought people's consent to their care and treatment. We saw that the home assessed people's capacity to make decisions. Those people who were assessed to lack capacity and where decisions were needed about care and treatment had these made by a multidisciplinary team to ensure they were made in the person's best interests.

We saw that the home assessed people's care needs and developed care plans which were reviewed with risk assessments in place. We saw that staff had training in caring for people with a dementia and that care plans took account of people's dementia care needs.This meant that people received the care they needed. We saw that people were protected from risk of harm through the correct recruitment practice, staff training and appropriate checks.

The home handled medication safely to protect people's health.

The home monitored the quality of it's service through surveys and internal systems so that improvements could be identified and put in place.

A relative stated that she and her mother had been consulted over a change of room and that it was in the best interests of the person living at the home that the change occured.

Relatives of people living at the home said they had been involved in the assessment process and had been consulted over care needs. They said they were regularly informed of any changes and were invited to contribute to reviews. They said staff always asked people if they could assist them and explained what they needed to do to help. People said that staff understood care needs. One relative said that staff call the doctor quickly if they have concerns and are good at passing information on about any changes in care needs or health. One person said: ‘They treat my mother well. When she was having difficulty settling they tried different things including helping her into the lounge at night when she couldn’t sleep and assisting with her instead of taking her back to bed.’

People said the food was good, that there was plenty of it and that tables were nicely set out. One relative said that the staff paid particular attention to ensuring their relative had adequate fluid intake after it was identified she was at risk of poor hydration.

People said they thought safety was a priority. When asked about the care of his relative, one person said. ‘I feel confident she’s in safe hands.’

People said that although staff managed care well, it occasionally seemed there were not sufficient staff on duty. One relative said that despite this, staff always had time to talk and be kind to people living at the home and thought that people still received the care they needed. One person said if there were more staff then people could be accompanied out of the home more often to have: ‘A breath of fresh air.’

People said the staff were knowledgeable about the people living at the home and about dementia in particular. One relative said: ‘It doesn’t matter which member of staff you ask they always know the answer to your query and if not they will make an effort to find out.’