This comprehensive inspection took place on 30 and 31 August 2018. The first day of the inspection was unannounced. The second day of the inspection was announced to the provider.

The inspection was carried out to determine what improvements the service had made since the previous inspection.

The previous inspection visit was conducted on 1 February 2018, 15 February 2018 and on the 5 April 2018. Following this inspection we asked the provider to take action to make improvements in relation to consent, safe care and treatment, safeguarding, good governance and staffing. The service was rated as ‘inadequate’ and placed into special measures as a result. This led to varying the terms of their registration. The provider sent us an action plan to tell us what they were going to do to make improvements, however during this inspection we found that insufficient improvements had been made.

RNIB Pears Centre for Specialist Learning; 5 Pears Court (Bungalow 5) provides specialist accommodation, nursing and personal care for up to six children and young people living with complex health and medical needs who require long term ventilation and/or other complex health requirements.

Bungalow 5 is one of a group of specialist built bungalows at the Pears Centre. The centre provides care for children and young people up to the age of nineteen. At the time of the inspection two children/young people lived in Bungalow 5 at the time of our inspection visit. Both of these children received accommodation and personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided. Therefore the quality of the accommodation and the care provided were looked at during this inspection.

The ethos of RNIB at the Pears Centre is to provide children with and young people with high levels of care in a homely environment, and to support and encourage them to participate in activities which will develop their social and communication skills. The centre also comprises of a specialist school, and children are encouraged to access education. The school and all on site accommodation are registered by Ofsted. Ofsted regulate and inspect services that care for and provide services for children and young people, and services that provide education for learners of all ages.

Only Bungalow 5 is registered with the Care Quality Commission (CQC).

One child in Bungalow 5 was due to be removed from the home and transferred to another placement. We had been made aware that alternative suitable accommodation is currently being sought by commissioners for the young person who is still placed in Bungalow 5. The RNIB have applied to cancel their registration with the CQC and Ofsted and are therefore working closely with commissioners to find alternative suitable placements for children accommodated at the RNIB Pears Centre for Specialist Leaning. Information and findings of the latest Ofsted report can be found on the Ofsted website.

There was no registered manager in post. 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. An interim manager operated the day to day running of the home who was on annual leave during the time of the inspection. This provided the inspection team with a good opportunity to determine how effectively the home was being managed in the absence of the interim manager.

Not all staff in Bungalow 5 had received the appropriate level of safeguarding training to ensure the safety of children and young people in their care. The provider had stated that staff would receive the appropriate level of safeguarding training for staff at the service, following our previous inspection visit on 1 and15 February and 5 April 20

The inspection took place on 1 February 2018, 15 February 2018 and on the 05 April 2018. The first and second day of our inspection visit was announced. We gave the provider 48 hours’ notice of our inspection visit, so that we could be sure the registered manager and staff were available to speak with us, and that our visits would not disrupt the care children and young people received at the home. On the third day of our inspection visit we visited the service unannounced. This visit was primarily to determine how the home was being managed on a daily basis as the registered manager had left the service and a new leadership team had been appointed to manage the home and make improvements.

RNIB Pears Centre for Specialist Learning; 5 Pears Court provides specialist accommodation, nursing and personal care for up to six children and young people living with complex health and medical needs who require long term ventilation and / or other complex health requirements.

Five Pears Court is one of a group of specialist built bungalows at Pears Centre. The centre provides care for children and young people up to the age of nineteen. Four children or young people lived at 5 Pears Court at the time of our first two inspection visits. These four children / young people received accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

When we inspected on 05 April 2018 one child had been removed from the service by commissioners, due to concerns about their care and welfare.

There was a registered manager in post at the time of our first two inspection visits in February 2018. In April 2018 the registered manager had left the service. An interim centre manager was in place with recruitment underway for a new registered manager. A requirement of the service’s registration is that they have 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.

This was the first time we had inspected the home under its current registration. The service had previously been registered under a different provider name under the RNIB legal entity. We have rated this service as Inadequate overall.

The ethos was to provide care to children and young people in a homely environment to encourage and support them with developing their social skills and provide them with opportunities to access education. There was a school and accommodation for children attending the school on the same site regulated by Ofsted.

We found safeguarding concerns were not always recognised by staff and managers when incidents occurred at Bungalow 5. Staff and managers had not received the appropriate level of safeguarding training to meet the needs of children and young people at the home.

Risks to people’s health and wellbeing were not always identified, and risk management plans were not always in place to instruct staff on how they should manage risks to people consistently and safely.

There were not always sufficient qualified and trained staff on duty to care for children and young people safely, and to meet their social needs. There was a lack of leadership for staff at the home, including clinical leadership.

We found there was no current analysis and overview of accidents, incidents, complaints, feedback and safeguarding concerns at the home to assess whether any trends or patterns were identified and future risks could be mitigated. The registered manager told us this was due to a lack of management resources at the Bungalow.

The registered manager and provider did not fully understand their responsibility to comply with the requirements of