We carried out a review of the data available to us about Crystal Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Crystal Court, you can give feedback on this service.
We found the following examples of good practice.
An area within the home had been adapted to accommodate visitors, in line with current guidance. COVID-19 guidance for visitors was available in different languages to facilitate compliance.
The area used for staff breaks was large and well ventilated to reduce transmission.
Infection prevention and control (IPC) procedures were clear and followed by staff. All staff were trained in safe IPC practices.
A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. There had been a good uptake of residents receiving the COVID-19 vaccine.
Crystal Court is a residential care home providing personal and nursing care to up to 60 people aged 65 and over, some of whom are living with dementia. At the time of the inspection, 54 people lived at the service. The service is set over two floors with three units.
People’s experience of using this service and what we found
Improvements had been made in all areas since the last inspection. People told us they felt safe and were cared for by kind and caring staff. People received their medicines on time and as prescribed by staff who had the skills and knowledge required. Staff followed good infection control processes and lessons were learnt when things went wrong.
People’s needs were assessed, and care plans were regularly reviewed to ensure information remained up to date and person-centred. People were fully involved in the planning of their care and their views were listened to and acted upon.
People had plenty to eat and drink and those who required assistance with their meals received appropriate support.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff knew people well and tailored support to meet their different needs. Staff engaged people in meaningful activity and relatives were free to visit the home at any time.
Systems were now in place to allow the manager and provider to continuously monitor the quality and safety of the service provided.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 16 January 2019) 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 the service. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.
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.
Feedback about the quality of the food was generally positive, but some people felt there could be a better variety of food available. We observed the dining experience for people varied, however the food smelt appetising and was nicely presented.
There were inconsistencies in staffs’ approach towards people. Some people told us staff were kind and treated them with respect and dignity. Others described how staff were not always gentle with them during personal care and felt some staff could be abrupt. We observed some warm interactions between staff and people who used the service. Staff spoke about people in a respectful manner and ensured people’s dignity and privacy was promoted.
A programme of activities was available to people but there were extensive periods of time where people did not have access to any opportunities for stimulation. Records did not demonstrate people had regular access to activities that were centred around their own personal needs and interests.
We have made a recommendation about ensuring people receive person-centred care.
People’s feedback had been sought about the running of the service. The most recent questionnaires were awaiting analysis by the provider. The questionnaires reviewed showed that whilst people were generally happy with the standard of care, there were some areas which could be improved including the answering of call bells and activities. Concerns raised through resident’s meetings were not consistently addressed or used to improve the quality of the service.
A series of meetings were held with staff and the people who lived at the home, to share important information about the running of the service.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing 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 this report