Hyne Town House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they felt safe living at Hyne Town House. They said staff knew them well, how to care for them and meet their needs. We observed staff supporting people safely, in a kind and caring manner. People who were able to share their views with us, did not raise any concerns about their living environment. However, we found certain aspects of the environment were not fully safe. For example, fire arrangements in two smaller properties where people were living, windows throughout the buildings not appropriately restricted and risk assessments were not in place for the use of bedrails. This was a continued breach of regulation 12. Whilst people told us they received their medicines when they needed them, processes for management of medicines stock were not robust. This meant the provider could not be assured people were receiving their medicines as prescribed for them. This was a breach of regulation 12. Risks to people’s health and wellbeing was managed and care plans and risk assessments were in place and contained guidance about how to manage or mitigate risk. However, some care plans could be improved further to ensure staff had enough information to provide safe care. People told us and we observed, there were enough staff to support people and meet their needs.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at Hyne Town House. They said staff knew them well, how to care for them and meet their needs. One person said, “Staff help me with anything I need them to help me with.” Relatives described what was in place to mitigate and manage risks associated with their relative’s care. For example, one relative told us, “Staff do regular skin checks for pressure sores or redness.” Other relatives described how staff supported people to safely walk around the service, one said, “He (person receiving care) needs supervision of 1 or 2 carers, there is a pressure mat in place, and they encourage him to stay in the lounge area where they can keep an eye on him.” Relatives also told us that risks in relation to nutrition and hydration were managed well. One relative said, “The food is monitored nutritionally, to ensure that he maintains his weight, they have asked a dietician to become involved.”

Staff knew people well and were able to tell us about their care needs and how to mitigate risk. Staff were able to describe how they managed people’s skin to prevent skin damage, monitored and recorded peoples’ food and fluid to prevent weight loss and what action they took to prevent people falling. Staff told us they had sufficient information in care plans and received updates on people’s care during daily team handovers. The registered manager told us they focused on enabling people to take positive risks ensuring they stayed as safe as possible whilst giving them choice and control.

During the assessment we observed staff supporting people safely, in a kind and caring manner. People at risk of skin damage had appropriate pressure relieving equipment in place, such as, airwave mattresses and pressure relieving cushions. Sensor alarm equipment was in place to alert staff and keep people safe who had been assessed as at risk of falling. We observed staff supporting and encouraging people to eat and drink when they were not able to eat independently.

Care plans and risk assessments were in place, up to date and contained guidance about managing and mitigating risk. However, whilst staff knew how to care for people and manage risk, some care plans could be improved further. For example, continence care plans needed further guidance about what might indicate a person’s catheter was not draining sufficiently and what action staff should take. People were being monitored and weighed regularly and advice had been sought from people’s GP and dietitians about how to help people gain or maintain their weight. However, some care plans had not been updated to reflect where people had lost weight and what action was being taken. This was discussed with the registered manager who said they would make sure this was addressed. People were protected from the risk of skin damage. Guidance was in place for staff to follow about how often staff needed support people with repositioning, skin cream application and daily skin checks. Repositioning charts evidenced that people were being repositioned regularly as required. Where people were at risk of falling, appropriate action had been taken, such as, increased monitoring and bed rails and sensor alarm mats were used to help ensure risks were reduced. Care records and risk assessments were regularly reviewed by the registered manager and senior staff as part of their governance systems and processes.

People who were able to share their views with us, did not raise any concerns about their living environment. For example, relatives told us they had witnessed fire alarm testing, and the service was always clean. Comments included, “I think it is clean here" and “It is clean, the cleaner comes in every morning. My commode gets cleaned after each time I use it."

The registered manager told us action had been taken to address concerns with fire safety following the last inspection. Records showed that Devon and Somerset Fire and Rescue Service were happy with fire safety arrangements within the service following their visit in November 2023. The registered manager said, each month staff at all levels carried out a number of audits and spot checks to ensure the premises were safe and suitable for the purposes for which they were being used. For example, general maintenance, water temperatures, equipment checks, safety testing and fire safety etc. Each month this information was shared with the provider for further review and follow up. However, we found audits and spot checks had not identified the concerns we found at this assessment. [see observation and process section] Staff we spoke with did not raise any concerns about the environment and told us the provider was always looking for ways to improve people’s experience. One member of staff said, “We offer people choice in how they would like their bedrooms decorated. People can choose what colour they want their walls painted, that makes a big difference to people’s wellbeing.” Another told us about the providers plans to improve access to one area of the garden making it fully accessible to people and their relatives.

Hyne Town House is a group of buildings (the main house and two smaller properties), which have been adapted to support older people, including those living with dementia. At the time of this assessment there was no one living in these smaller properties who were in receipt of a regulated activity. However, we found these buildings, did not have suitable window restriction and there was no system in place to ensure that smoke alarms were being regularly tested and remained in good working order. The main house was set over three floors, which were accessible via a lift or staircase. The service had adapted bathing facilities, including hoists, and raised toilet seats. Externally, there was a patio and garden areas, which people and their relatives could freely use. People told us they were involved in the decoration of their bedroom. For example, people were able to choose the colour scheme and supported to personalise their rooms with possessions that were important to them. We found some windows in the service had not been fitted with a suitably robust tamper proof restrictor to ensure compliance with health and safety legislation.

Whilst environmental checks and audits were in place, these did not always identify concerns or drive improvement. For example, the provider had addressed previous concerns raised about fire safety within the main house, in that fire safety systems within the main house were now being audited regularly. However, we found the provider had not fully considered fire safety arrangements within the two smaller properties where people were living. Checks and audits in place had not identified that some windows in the service had not been fitted with a suitably robust tamper proof restrictor to ensure compliance with health and safety legislation. Weekly equipment audits in relation to the safe use of bedrails, did not identify that staff had failed to carry out bedrail risk assessments prior to their use. This meant people were potentially exposed to the risk of avoidable harm as the provider could not be assured that bedrails were appropriate or that action had been taken to mitigate any associated risks relating to their use. The failure to effectively manage and mitigate risks, placed people and staff at an increased risk of avoidable harm. This was a continued breach of regulation.

People told us staff were kind and were quick to provide care and assistance. One person told us, "I’m quite happy. The staff, well everyone, talks to me and makes me feel loved." Most people told us that staff did have enough time to meet their needs and spend time with them. One person said, “If I am feeling lonely, I can use my bell and the staff come up and see me." Another commented, "At times staff can be busy in that moment, but they will come and help you." Relatives told us they felt there were enough staff to care for people. Comments included, “There seems to be plenty of staff, if he (person receiving care) uses his call bell or steps on the pressure mat, they are there immediately”, “I can find someone when I want someone, and the call bell is responded to quickly” and “There appears to be a lot of staff.” However, one relative did comment, “I think that he is generally well looked after, but they are a wee bit understaffed. They seem to have quite a staff turnover.”

Staff told us there were enough staff to care for people and meet their needs. One staff member told us, “Yes, most of the time we have 5 staff, and we are ok. We do get time to spend with the residents as well as doing our tasks.” Staff were happy in their roles and felt well supported. They told us they received appropriate training and supervision.

During our site visit we observed people being supported by enough staff. Staff spent time talking with people and providing them with assistance when needed.

People were cared for by staff who had been safely recruited. Records confirmed staff received regular supervision and appraisal to help them develop within their role. The staff training matrix confirmed staff received training appropriate to their roles. New staff received an induction and were able to spend time shadowing experienced members of staff before working alone. The provider used a dependency tool to help determine staffing levels.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they received their medicines when they needed them, and staff made sure they took their medicines. One person said, “Staff watch me taking my medication and will give them to me.” Another person told us, “Staff bring them to me. It’s always the right time for me. I would have them in the morning and evening at home, and it is the same here. I always check I have 6 tablets.”

The registered manager told us there were systems in place for recording, reporting, and investigating any medicines errors and that medicines were audited monthly through a series of audits and spot checks. The deputy manager described how each month, staff undertook a review of each person’s medicine and carried out a stock take. This enabled them to identify any issues and escalate any concerns. Staff told us they felt medicines systems generally worked well and they had supplies of medicines when they needed to be given. Staff told us they received training and had their competencies checked before they were able to administer medicines.

There were processes in place to ensure people received their medicines safely. However, we found the system in place to review stock balances could not be relied upon. For example, records showed staff consistently documented discrepancies in the number of medicines held by the service but failed to take any action to investigate why the stock balances were incorrect or identify what was going wrong. We discussed what we found with the registered manager and the provider who were unaware of the number of discrepancies in stock balances being recorded by staff. They told us this was most likely a system issue and assured us they would investigate this as a matter of urgency. The failure to effectively manage medicines stock levels placed people at an increased risk of avoidable harm. This was a breach of Regulation 12.