Archived: RNIB The Clockhouse

Updated 10 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This was a re-inspection of this service to check whether the provider was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide an updated rating for the service under the Care Act 2014.

This inspection took place on 6 June 2018 and was unannounced. The inspection team consisted of two inspectors.

Before the inspection, we reviewed records held by CQC which included notifications, complaints and safeguarding concerns. A notification is information about important events which the registered person is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection. The provider also completed a Provider Information Return (PIR) before our inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

As part of our inspection we met with all of the six people who lived at the service. As some people were not able to give us verbal feedback about their experience of the service, we spent time observing their support and interactions with staff. Following our visit to The Clockhouse we gathered feedback from four family members. We spoke with five staff, including the registered manager. Through the LSE process we have also been gathering regular feedback from the local and placing authorities.

We reviewed a variety of documents which included the care plans for three people, four staff files, medicines records and other documentation relevant to the management of the service.

Updated 10 July 2018

The inspection took place on 6 June 2018 and was unannounced.

RNIB The Clockhouse (The Clockhouse) 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.

The Clockhouse provides residential care to a maximum of six adults who have sight difficulties. 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 inspection was facilitated by the registered manager. 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 24 February 2016 when we rated the service as Good. At that inspection, there was no registered manager in post and the leadership of the service required improvement. 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 The Clockhouse was not wholly suited for the stated purpose of the service. In particular, the layout and stairways were not suitable 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.

As a result of concerns raised about the service from a number of different sources, The Clockhouse 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 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 The Clockhouse. 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 safe and happy.

The management team have been open about the actions they were still working on and had clear plans in place to ensure good outcomes for all were achieved. We made one recommendation as a result of this inspection in order to encourage the provider to continue to develop best practices for people living with a visual impairment. We will continue to review the service against their own improvement plan, in particular ensuring the provider continues to monitor and support the service.

Until recently, the operational focus for the management team had been on rectifying previous mistakes in order to ensure people received a safe and personalised service. Now those objectives had been achieved, governance frameworks need to be embedded and sustained to ensure a future of consistently proactive and high quality support.

People were protected by the systems in place to safeguard them from the risk of harm. In particular, the procedures for managing people’s finances have greatly improved and help prevent the risk of abuse.

The service was clean and hygienic and appropriate steps had been taken to ensure good infection control.

There were now sufficient staff in place to meet people’s needs and deliver a more personalised service. People had good relationships with the staff who supported them with kindness and compassion. Staff had access to training and support that enabled them to undertake their roles effectively and ensure people’s legal rights were protected.

Staff and management worked well as a team to enable people to maintain good health. There were systems in place to ensure people received their medicines as prescribed. Staff responded swiftly to any changes in people’s needs and sought specialist healthcare advice as necessary.

People had choice and control over the way in which they spent their time and now had regular opportunities to engage in meaningful activities. Care plans and risk assessments were in the process of being reviewed and updated to ensure they fully reflected the support being provided.