Archived: RNIB Gladstone House

We found the following examples of good practice.

When visiting to the service was not possible people had been supported to stay in regular contact with friends and family using telephone and video calls.

Staff received regular training about infection prevention and control including specific training about personal protective equipment (PPE) and how to use it correctly.

Cleaning had increased during the COVID-19 pandemic and frequently touched surfaces such as light switches and door handles were cleaned regularly everyday to reduce the risk of infection. There were hand sanitizer dispensers readily available around the service.

People living at the service had individual COVID-19 risk assessments which were regularly reviewed. These were used to help identify factors which might make them particularly vulnerable to COVID-19 and how these risks could be reduced.

RNIB Gladstone House (Gladstone House) is a residential care home providing personal care to up to six people who are living with sight loss. People may also have additional learning disabilities, autism, emotional or mental health needs. There were six people living in the home at the time of our inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The last twelve months had continued to be a period of change at Gladstone House, with several different managers taking responsibility for the leadership of the service. Whilst this had naturally created a period of uncertainty for people and their relatives, a consistent core of staff, along with greater provider oversight had ensured that people achieved good outcomes. A new quality assurance framework and a clear development plan for the service had identified how further improvements to auditing and record keeping were going to be embedded and sustained.

Comprehensive assessments and care plans provided the basis of personalised care and ensured that staff supported people safely and in accordance with their needs and preferences. Risks to people were identified and managed in a way that balanced their safety with their right to freedom, choice and independence.

Staff continued to facilitate opportunities for people to engage in a range of meaningful activities, work towards goals and learn new skills that were personal to them. People were encouraged and supported to lead active and healthy lifestyles. People maintained relationships with those who were important to them and had opportunities to make new friends.

Staff were kind and passionate about their roles and had developed relationships with the people that were inclusive and fun. Staff championed people’s rights and worked collaboratively with each other and external partners to deliver a high standard of support.

People were now actively involved in the running of the service and regularly consulted about all aspects of their care and life within the service.

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 24 October 2018) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. 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.

RNIB Gladstone House (Gladstone House) is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Gladstone House provides residential care to a maximum of six adults who are either blind or partially sighted. They may also have additional learning disabilities, autism, emotional or mental health needs. There were six people living in the home at the time of our inspection.

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service has a registered manager, although they were on leave at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We previously carried out an unannounced comprehensive inspection of this service 23 June 2016 when we rated the service as Good. Since that inspection, a new registered manager has been appointed and the service has undergone a significant level of change at both provider and management level.

The physical environment at Gladstone House was not suited for the stated purpose of the service. In particular, the layout and stairways were not wholly appropriate for people living with visual impairment. The provider is aware of this shortfall and the RNIB are undertaking a major re-development project to provide more suitable accommodation to all the people they support across their services.

Along with its sister service (The Clockhouse), Gladstone House has recently been the subject of a Large Scale Enquiry (LSE) which was led by the local authority safeguarding team. Throughout this process, the provider and registered manager have cooperated with the investigation and extensive external auditing of the service has taken place. We have participated in the LSE and have been monitoring the service through regular phone calls, attending safeguarding meetings and reviewing ongoing improvement plans for the service.

The operational focus for the management team has been on implementing new systems to ensure people receive a safe and personalised service. A crucial part of this process has been recruiting a new and stable staff time for Gladstone House. This has been a period of considerable uncertainty and change both for the people living at the service and for their family members. We have spoken with relatives throughout the LSE and also as part of this inspection and the feedback from all stakeholders is that whilst the service is not yet perfect, it has significantly improved and that people living at the service are looked after and happy.

The registered manager is responsible for both Gladstone House and The Clockhouse and until recently the primary focus had been on improving The Clockhouse, where the risks were higher. The management team were open about the fact that progress had therefore been slower at Gladstone House and shared the actions they were still working on to secure consistently good outcomes at this service.

We made two requirements about risk assessments and consent and one recommendation about best practice as a result of this inspection. We will also continue to review the service against their own improvement plan, in particular ensuring the provider continues to monitor and support the service and that there is sufficient leadership and oversight at both this location and The Clockhouse.

Whilst staff had a good understanding of people’s individual support needs, some risks had not been properly assessed and mitigated. The service was asked to immediately consider how it could reduce the risk of one person propping open a fire door each day.

Staff respected people’s choices, but the application of the Mental Capacity Act 2005 (MCA) was not always consistently applied in a way that fully protected people’s legal rights. Care records did not fully reflect when how decisions had been made and it was not possible to ascertain whether best interests’ principles had been followed in those situations where people were unable to consent for themselves.

There were sufficient staff to support people safely and in accordance with their needs. Appropriate checks were undertaken to ensure only suitable staff were employed. Staff had the skills and experience to support people effectively and safeguard them from abuse.

People were supported to remain healthy and well. Medicines were managed safely and people received their medicines as prescribed. People were supported to maintain a healthy and balanced diet.

Support was becoming increasingly person centred and staff responded appropriately when people’s needs changed. People were encouraged to be as independent as possible and any concerns raised were taken seriously and acted upon. Access to meaningful activities was improving as staff continued to explore new opportunities for people to spend time doing the things they enjoyed and were interested in.

People had good relationships with staff who supported them with compassion, enthusiasm and respect for their individual and diverse needs.