This inspection took place on 30 October and 7 November 2018. The first day of the inspection was unannounced.

Crystal Court is situated in Harrogate and is registered to provide residential and nursing care for up to 60 people some of whom may be living with a physical disability or 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. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation was provided within one building which was separated into three units where people lived according to their specialist needs. People had their own room, access to large communal spaces and outdoor space. At the time of our inspection there were 48 people living 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 time of our inspection a registered manager was not in post. The provider informed us the position had been offered to a person and they were awaiting confirmation of their start date. The business manager, with oversight from the regional manager, was managing the service on a day-to-day basis in the interim period.

Staff were not effectively deployed to meet people’s needs in a timely manner. Staff and people who used the service expressed their concern to us about staffing levels. Staff worked in a task centred way and did not spend enough quality time with people outside of planned activities.

Although staff had received moving and handling training, we observed the use of poor moving and handling techniques during our first day at the service. We highlighted this to the provider who took appropriate actions by the second day of our inspection.

Inductions for new members of staff were not monitored to ensure they were making sufficient progress within their role. Probationary reviews were not completed to ensure people were happy within their role and to discuss any additional learning needs. Staff undertook training the provider considered mandatory. However, training specific to the needs of the people who used the service was not in place.

Risk assessments and care plans did not consistently contain up to date information about people’s needs. Reviews of people’s support were completed on a regular basis but they did not demonstrate people’s involvement in their support.

The provider had a programme of quality assurance checks to monitor the safety and quality of the service provided. The checks had not consistently highlighted the issues we found during our inspection. This increased the potential risk to people and resulted in shortfalls in governance.

People told us they received their medicines as needed and staff undertook training to ensure they had the necessary skills and knowledge. However, there were gaps within some people’s medicine administration records and best practice in relation to the recording of medicines administration was not consistently followed.

We have made a recommendation about the implementation of best practice guidance in relation to the management of medicines.

Staff undertook safeguarding training and were aware of potential signs of abuse and who to report their concerns to. Staff continued to be recruited in a safe manner. The home was clean and there were no malodours and staff understood the actions to take to prevent and control the spread of infection.

Mental capacity assessments were not consistently completed when a person was thought to lack understanding in relation to a part of their lives.

We have made a recommendation about ensuring understanding and adherence to the Mental Capacity Act.