The inspection took place on 29 August 2018 and was unannounced.

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 s