Archived: RNIB Gladstone House

RNIB Gladstone House is a care home providing accommodation and personal care for up to six people who are aged 18 and over and have sight difficulties. They may also have additional learning disabilities, autism, emotional needs or mental health issues. There were four people living in the home at the time of our inspection.

The inspection took place on 7 July 2015 and was unannounced.

The home had a registered manager. 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 physical environment was not safe and risks were heightened due to people’s visual impairments. We found that fire escapes were cluttered with garden debris and other items. The garden was overgrown, pathways uneven and unused objects left lying on the floor.

Internal areas such as unguarded windows, uncovered hobs and steep stairways had either not been risk assessed or where they had, no controls put in place to keep people safe from harm. It was not clear what steps the manager had taken to ensure the safety of people living at the home.

People had lived in the home for a number of years and were now well orientated with their environment. They told us that it had been difficult when they first moved in. With two vacant rooms, the environment poses additional risks for those who may be about to move in.

Daytime staffing levels provided people with the opportunity to live active lives, but at night it was not clear whether one person sleeping-in between the hours of 11pm and 7:30am promoted choice and protected their safety. People told us that they were expected to be in bed between these times because staff were “Off duty”. The fire risk assessments for people indicated that in the event of a fire each person would be sight guided by staff to evacuate the building. It would not be possible for one person sleeping in to facilitate this.

The registered manager is responsible for four other locations in addition to RNIB Gladstone House and as such is not in day to day charge of the home. Team leaders and deputy team leaders provided day to day management and oversight. Due to recent staffing changes at the service there had been a lack of leadership and direction. The provider’s auditing systems had failed to fully identify the shortfalls and respond to them in a timely way.

The staff changes had created a period of uncertainty for the people living at the home. They described feeling “Unsettled” and felt that the home was “Short staffed”. We found that the provider had taken steps to minimise the impact through the use of regular temporary staff, but people’s routines had been affected at this time.

RNIB Charity had a programme of training for staff and all staff had completed learning in supporting people living with visual impairment before they worked alone with people. Two staff members who had been employed for several months had not completed induction training in line with the provider’s own expectations. This had recently been identified and was now being done, but it was not clear why they had not been more closely supervised at the start of their employment.

People were complimentary about the friendliness of staff and we observed positive relationships with lots of laughter and friendly banter between people and staff. The atmosphere was relaxed and people told us “Everything is good about this house.” People said they were happy to live there and had no wish to be anywhere else.

People told us that staff spent time with them discussing and planning their care and felt consulted with and involved in all aspects. Staff had a good understanding about people’s legal rights and respected their legal capacity to make decisions for themselves.

People received support that kept them physically healthy and had access to a wide range of activities that were meaningful and interesting to them. People told us that “Staff always encourage me to be as independent as possible.” Although, greater opportunity for people to be involved in preparing their own meals would be beneficial in developing their independent living skills further.

Food was plentiful and provided people with choice and variety. Staff acted on professional advice where people had dietary needs.

The registered manager had set up a range of systems to ensure people were regularly consulted with and feedback about the service sought. We saw that people were encouraged to speak openly and when they did, they felt listened to and valued.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.