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Elsinor Residential Home Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 1 November 2019

About the service

Elsinor Residential Home is a residential care home providing personal care to 35 people aged 65 and over who may be living with dementia in one adapted building. At the time of this inspection 29 people were living at the service.

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

Governance systems had not been established and fully embedded into the service. Provider audits to monitor the quality and safety of the service were not effective.

Staff new to the service were not provided with a sufficient induction. Staff had not been provided with sufficient support and training to ensure they had the skills and knowledge to carry out their role.

Risks to people had not been consistently assessed. Risk assessments did not provide staff with sufficient information. We have made a recommendation about the management of risks. Medicines had not always been stored safely and recorded appropriately. Staff had not received appropriate medicines training. We have made a recommendation about the management of medicines.

Care plans did not always contain up to date information. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Capacity assessments and best interest decisions were not recorded. We have made a recommendation about MCA.

People told us they liked living at the service and felt safe. Support was provided by a consistent team of staff who had a good understanding of people’s care and support needs. Staff were visible around the service and it was clear positive, caring relationships had been developed. Improvements had been made to the recruitment process.

People and staff spoke positively of the new registered manager. The registered manager had begun to implement improvements since commencing employment and was committed to ensuring people were provided person-centred care and support.

For more details, please see the full report which is on the CQC website at

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 September 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, response and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.


We have identified breaches in relation to the governance and staff training and support at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Inspection areas


Requires improvement

Updated 1 November 2019

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 1 November 2019

The service was not always effective.

Details are in our effective findings below.



Updated 1 November 2019

The service was caring.

Details are in our caring findings below.


Requires improvement

Updated 1 November 2019

The service was not always responsive.

Details are in our responsive findings below.


Requires improvement

Updated 1 November 2019

The service was not always well-led.

Details are in our well-led findings below.