This unannounced comprehensive inspection took place on 23, 24 and 25 May 2018.

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

This unannounced inspection took place on 24 and 25 August 2016. This was the first comprehensive inspection since a change of provider took place in November 2015.

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 intera