Hyne Town House

Hyne Town House is a residential care home providing personal care for up to 45 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 20 people using the service.

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

The provider did not have effective systems in place to monitor the quality of care and support that people received. Audits had not been effective in identifying and addressing where improvements needed to be made. We found where improvements had been made at the last inspection, these had not been sustained.

People were not always protected from risks associated with their environment. Where risk had been identified, people’s care plans and risk assessments lacked detail and did not always guide staff about how to manage or mitigate risk.

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. Mental capacity assessments and best interests decisions were not always in place where people had restrictions placed on them.

Care plans did not always contain sufficiently detailed person-centred information to guide staff on how to meet people’s needs. Despite some activities happening at the service, people continued to tell us they felt bored, and they were not always supported to follow their interests and take part in activities they enjoyed doing.

We made a recommendation to the provider about seeking guidance and understanding of The Accessible Information Standard.

People told us they were happy, they felt safe, and staff understood how to keep them safe. People told us staff were kind, caring and treated them with respect.

People were supported by staff who were recruited safely and there were enough staff to keep people safe and meet their needs.

People were protected by good infection control processes and lived in an environment that was clean and hygienic.

Medicines were managed safely.

People were supported to eat and drink enough and had access to healthcare when they needed.

Staff felt supported within their roles and felt confident to discuss any concerns they had with the management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (focused inspection published 12 January 2021).

Following the last comprehensive inspection in 2019 the provider completed an action plan to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last comprehensive inspection in 2019.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person centred care, the Mental Capacity Act and governance oversight systems at this inspection. We have also made a recommendation in relation to the Accessible Information Standard.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 the provider's progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hyne Town House is a residential care home registered to provide accommodation and personal care for up to 45 people. The main three-storey building had 36 bedrooms, three of which could accommodate two people. At the time of inspection, the service was providing accommodation with personal care for 23 people. There were also three self-contained units on the site which could accommodate six people. At the time of inspection, these units were in use, however no one was receiving personal care. We therefore did not inspect them.

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

The service was safe. Improvements had been made since the last inspection. People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. One person said; “Oh gosh, they (staff) are so caring!”

Records of people's care had been updated since the last inspection, and were person centred, detailing individual needs and preferences. There were now clear records to show, staff were monitoring people’s specific health needs. Where people had been assessed as requiring pressure relieving mattresses, to protect them from skin damage, there was an improved process in place.

Other improvements included on how risks were identified, assessed, monitored and reviewed. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm. Equipment was regularly checked and audits were completed. This included environmental checks.

The management of medicines had improved since the last inspection. We found records of the temperature of the refrigerators, which stored medicines temperatures were recorded and audited regularly.

Staff were recruited safely in sufficient numbers to ensure people's needs were met. There was time for people to have social interaction and activity with staff. Staff knew how to keep people safe from harm.

Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. During the summer months some families had met people in the garden and new arrangements were in place for families to meet in a safe area of the home during the winter months.

The employment of two managers to manage the service helped ensure these improvements continued. Staff agreed the service had improved and was a ‘happier place to work’ since the managers were in post. Both managers where in the process of registering with the Commission. One staff member said; “The changes that have been made are for the better.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (Published 31 December 2019) where there were four breaches of regulation.

The provider was required to send us monthly reports detailing the improvements they had identified and what action they had taken as a result. We have reviewed these reports.

At this inspection we found improvements had been made and the provider was no longer in breach of three of the regulations. The fourth breach of regulation was not considered in this inspection. Therefore, we are unable to confirm the home is still in breach of this regulation.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same as the last inspection, required improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hyne Town House on our website at www.cqc.org.uk.

Hyne Town House is a residential care home registered to provide accommodation and personal care for up to 45 people. The main three-storey building had 36 bedrooms, three of which could accommodate two people. At the time of inspection, the service was providing accommodation with personal care for 34 people, although two had been admitted to hospital so were not resident at the time of inspection.

There were also three self-contained units on the site which could accommodate six people. At the time of inspection, these units were either vacant or were providing accommodation without personal care to people who required assisted living. We therefore did not inspect these units.

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

There were insufficient staff to ensure that people were supported to lead as independent lives as possible while remaining safe. There were some occasions when the lack of staff meant people did not receive the personal care they needed in a timely way. Staff were not given clear guidance and instruction about how they should ensure people who needed closer observation were kept safe. Staffing levels were insufficient to ensure people were supported to do regular meaningful activities whether in communal areas or in their own room. Staff were generally caring and compassionate when delivering care to people. However, the use of room numbers rather than people’s names when staff referred to a person meant people were ‘depersonalised’. Some staff used inappropriate language when discussing people who at times displayed behaviour that could challenge others.

There was a registered manager and senior staff from the provider organisation, who understood their responsibilities, including their duty of candour. However, some aspects of quality assurance and governance did not fully ensure the quality and safety of the service. This included the safety of air mattresses and water temperatures.

Staff were recruited safely and underwent training when they started. Training was updated regularly which helped to ensure staff remained aware of current best practice.

The home was clean and generally well-maintained. However, although audits and checks on hot water taps and air mattresses had been undertaken, actions had not been taken when issues were identified to ensure people were kept safe. There were insufficient clinical waste bins.

Medicines were administered safely. However, temperatures for medicines which required refrigeration had been recorded at unacceptable levels without action being taken to address this.

People and their loved ones, as well as visiting professionals, were generally complimentary about the service.

There were systems, which people and their families knew about, to raise concerns. Where concerns were raised, action was taken by the registered manager to resolve the problem. The registered manager and senior staff reviewed incidents and accidents. They used this information to improve the service and reduce the risk of a reoccurrence.

People were supported to have choice. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were assessed when they first came to Hyne Town House and care plans were developed to support their ongoing care. However, the care provided did not always reflect the information in the care plan.

People were supported to have a healthy diet they enjoyed and remain hydrated. However, some people were not supported to eat in a comfortable and suitable place, such as at a dining table.

The service supported people to make their own decisions as far as possible and within the requirements of the Mental Capacity Act 2005. Staff supported some people to remain as independent as possible. For example. by carrying out daily tasks and activities independently. However, there were some occasions where people were not encouraged to have a choice.

People’s communication needs were understood, and people were supported to maintain their health, Staff contacted and took advice from health professionals when needed. People and their families had been involved in developing their care plan and reviewing it from time to time. Care plans reflected people’s cultural, social and personal preferences. Families and friends were encouraged to visit and made welcome by staff. People were supported to have a peaceful and dignified end of life.

After the inspection, the registered manager sent details of actions they had taken to address the concerns. This included changes to staffing and work practices as well as addressing environmental risks.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 15 August 2018).

Follow up

The service remains rated requires improvement.

At this inspection we have made recommendations about the provider considering best practice guidance in support of older people mealtimes and supporting people with dementia. We also recommended the provider consider best practice on record keeping and reviews the guidance on ratings display.

We have identified four breaches in relation to the management and governance of the service, ensuring person centred care, the safe care and treatment of people and staffing levels.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hyne Town House on our website at www.cqc.org.uk.

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.

We brought this comprehensive inspection forward as we had received concerns about staffing levels; poor communication and information for staff, including agency staff; a lack of care plans to direct care; poor documentation in relation to diet and fluids; poor care for people living with dementia and the number of falls and pressure damage to people’s skin. Concerns were also raised about the attitude and approach of some staff.

Some of these concerns were investigated by the local authority safeguarding team. The safeguarding team had shared the concerns with the provider and action had been taken to improve records prior to the inspection, although this work was still progressing. The safeguarding process was closed shortly after this inspection took place as the concerns were not substantiated.

We found the service had experienced staffing difficulties with recruitment and sickness absence. However, regular agency staff were used to cover shortfalls and the provider was advertising for staff. We have made recommendation in relation to the deployment of staff. Staff reported good communication between the team and agency staff confirmed they had been given detailed handovers and induction prior to working with people. All people using the service had a care plan at the time of the inspection. Some records were poorly completed and did not demonstrate that the care required had been provided. The community nurses confirmed that only person at the service had minor damage to their skin, and this was healing. If people experienced falls or injuries were sustained as a result of falls, this was recorded and reported to the Care Quality Commission (CQC). Our comparison data with similar services shows no evidence of risk at the service.

We last inspected the service August 2016. No breaches of regulation were found and the overall rating was good. However, the responsive key question was rated requires improvement. This was because there was no regular programme of activities for people to take part in. We also recommended that staffing levels were kept under review.

Hyne Town House is registered to provide accommodation and personal care for up to 45 older people. Thirty-nine rooms are located in the main part of the service. Three flats had been built on to the side of the main building, with each flat registered to provide accommodation for two people. On the day of the inspection 29 people were receiving care in the main part of the service. One person was living in a flat, but was not receiving personal care.

A registered manager was employed at the service. They were on maternity leave at the time of the inspection. However, they did attend on the first day of the inspection to support staff and assist with the inspection. 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.

Arrangements were in place for the daily management of the service in the absence of the registered manager. Two experienced and qualified care staff were acting as assistant deputy managers until the return of the registered manager. The managers said they had good support and regular contact with the provider.

We found improvements were required at this inspection. Although there were quality assurance systems in place, including audits and checks, they had not identified the shortfalls we found. People’s records did not reflect the care and support delivered. Records in relation to diet and fluid intake and repositioning for those at risk of pressure damage were poor. This meant people at risk of malnutrition or dehydration could not be effectively monitored by staff and other health professionals.

No concerns were raised by health professionals about people’s skin care or hydration, however poor records meant it was sometimes difficult for professionals to make clinical decisions. The managers were taking action to improve records by monitoring them each day. This was being imbedded and shared with all staff at handover.

Audits had not identified the shortfalls we found with the management of medicines or that fire checks and fire safety records were not being completed.

Risks associated with people’s safety and wellbeing had been identified however the provider did not ensure all reasonable measures were followed to mitigate some risks.

The service was not consistently following safe practice in relation to medicines management. We have made a recommendation to improve some aspects of medicines management.

Staffing levels at the service were meeting people’s care needs; however, we have recommended the deployment of staff be reviewed to ensure people’s needs are met safely and in a timely way.

Activities and meaningful occupation were an area identified for improvement by people using the service and some relatives. We have recommended advice and guidance is sought to ensure people have a variety of suitably stimulating and meaningful activities to occupy them.

The premises were well maintained and the provider had considered how to improve the environment for people living with dementia. A number of environmental improvements had been completed since the last inspection. This included, specialist flooring and the use of non- reflective bright paint colours to enhance the light in the corridors.

People said they felt safe at the service and relatives expressed their confidence in the care and support provided. Staff supported people to be as independent as possible, at the same time protecting them from risks to their safety. There were systems in place to safeguard people from abuse and staff had a good understanding of their role in protecting people from harm and abuse. Staff recruitment processes were robust.

The service was clean throughout with no unpleasant odours. There were several communal areas for people to use and a pleasant secure garden patio. We saw several people enjoying the outside space.

People were cared for and supported by staff that understood their needs and knew them well. Staff received training and support to enable them to do their job safely and effectively.

Staff treated people with dignity and respect. End of life care had been provided with sensitivity and respect for people’s needs and individual wishes. People felt able to make decisions about their care and the staff respected those decisions. Staff were mindful of people’s needs regarding equality, diversity and human rights. The service was meeting the requirements of the Mental Capacity Act 2005 and the Accessible Information Standard.

People’s health needs were monitored and met to help them to live well. The service worked with relevant health care professionals. People enjoyed the food and were offered a varied and nutritious diet.

People felt able to raise concerns with the registered manager. When a complaint had been received it had been investigated, responded to and resolved.

People were involved in the service and their views were sought. Action was taken where suggestions for improvements were made. People and their relatives felt the service was well managed.

We identified two breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Hyne Town House is registered to provide accommodation and personal care for up to 45 older people. Thirty-nine rooms are located in the main part of the service. Three flats had been built on to the side of the main building, with each flat registered to provide accommodation for two people. On the day of the inspection 33 people were receiving care in the main part of the service. One person was living in a flat, but was not receiving personal care.

A registered manager was 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. The registered manager was due to retire a few weeks after the inspection. A new manager had been appointed and was working alongside the registered manager until they retired.

Prior to the inspection we had received some concerns about the service from agency staff. The concerns were about a lack of information given to agency staff prior to them starting work at the service, bedroom doors being locked and some people not getting their breakfast. The local safeguarding team had looked into the concerns and the service had made some changes to the information agency staff were given prior to starting work. Some people living at the service had recently been reviewed by the continuing healthcare team, who had not identified any concerns about their care.

Other concerns had been received about staff using poor moving and transferring techniques. During the inspection we saw that staff used good techniques when helping people to move about and transfer from one seat to another.

People’s needs were met as there were sufficient staff on duty. During the inspection we saw people’s needs were met in a timely way and call bells were answered quickly. However, people and staff told us that due to the use of agency staff it sometimes seemed as though there were not enough staff on duty. The registered manager was aware of the issues and was actively recruiting permanent staff.

People received individualised personal care and support delivered in the way they wished and as identified in their care plans. People’s care plans contained all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed. However, care plans were large documents and contained much repeated information. The registered manager was taking action to simplify care plans.

Care plans did not contain individual activity plans to ensure people had meaningful activities to promote their wellbeing. Information about the person’s life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. This meant there were limited opportunities for social interaction between staff and people living at the service. There was no regular programme of activities for people to participate in. The registered manager told us activities were provided ‘spontaneously’ rather than at a specific time of day. They told us that there was an action plan in place to improve activities. This included delegating one staff member to record and oversee activities and to increase outings.

Not everyone living at Hyne Town House was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. Each time staff entered the lounge they spoke to people and tried to engage them in conversation.

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

People’s needs were met by kind and caring staff. One visitor told us Hyne Town House was “The best”. People told us “Everyone is so good and kind to me”, “Lovely views and lovely people to care for me”. People’s privacy and dignity was respected and all personal care was provided in private. Everyone had their own bedroom.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet and people told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals. Following the inspection we received an email from a local GP who wrote ‘The friendly staff are appropriately knowledgeable and capable of identifying causes for concern and taking basic observations. Visit request are appropriate’.

People and their relatives could be involved in planning and reviewing care if they wished. Relatives told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with vulnerable people.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

The registered manager was very open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the registered manager. One told us “Can just go and talk to [registered manager] and she will pick you up if you are having a bad day”.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. Monthly audits were undertaken including medicines, care plans and accidents and incidents. We saw that where issues had been identified action was taken to rectify the matters. Annual audits were also undertaken including looking at infection control and the way people’s dignity was managed. The registered manager also carried out an annual survey to gauge the views of people using the service, staff and relatives. Results from the 2016 survey showed a high level of satisfaction.

Prior to the inspection a director of the company had completed a Provider Information Return (PIR). This is a form that asked the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR told us that the providers planned to renew the patio area of the service. We saw that this had been completed. Records were well maintained.

We have made a recommendation relating to staffing levels.