The Meath Epilepsy Charity

About the service

The Meath Epilepsy Charity (The Meath) is a residential Care Home providing personal care to up to 84 people who are living with epilepsy and may have associated learning and/or physical disabilities. There are nine individual houses/flats within the service, each of which has a manager and senior staff. There are communal resources available to all those living at The Meath including a skills centre, café and gym. At the time of our inspection there were 84 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Based on our review of the key questions Safe and Well-led, the service was not fully able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support:

The model of care in a large and complex service did not always take people’s individual needs and risks into account. Processes to assess and monitor risks were not consistently implemented across the different areas of the home.

People told us they felt safe living at The Meath and we observed people were relaxed in the company of staff. However, we found although safeguarding concerns were reported promptly there had been delays to fully responding to one safeguarding concern which had impacted on people’s well-being. In other instances, we found safeguarding concerns had been responded to promptly.

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

Right Care:

People’s medicines were not always stored safely in line with guidance. People received their medicines in line with their prescriptions. Where appropriate, people were supported to manage their own medicines.

There were sufficient staff deployed to meet people’s needs and wishes. A number of agency staff were used to cover staff vacancies. Wherever possible the same agency staff were used which provided people with a consistent approach.

Right Culture:

The provider did not always operate effective systems to monitor the quality of the service they provide. Audits were not comprehensive and had failed to identify shortfalls in relation to risks to people’s safety, medicines management and the use of PPE.

There was a positive attitude and ethos in the way people were supported which led to people developing independence and doing things they enjoyed. Local links had been established which further enhanced people’s lives within the area the lived.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 07 October 2021)

Why we inspected

The inspection was prompted in part due to concerns received about how the risks of sudden unexpected death in epilepsy (SUDEP) were managed. Following a review of an incident the provider forwarded an action plan of steps they would take to enhance staff understanding and risk monitoring. A decision was made for us to inspect, examine those risks and the progress made with the action plan. We undertook a focused inspection to review the key questions of safe and well-led only.

We found that some aspects of the action plan had been completed including reviews of people’s epilepsy risk assessments, night-time care plans and development of staff understanding of SUDEP. However, we found further work was required. This included completion of more individualised SUDEP risk assessments and consistent monitoring. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Meath Epilepsy Charity on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, safe storage of medicines and governance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Meath Epilepsy Charity (The Meath) provides accommodation with personal care for up to 84 adults who are living with epilepsy and may have associated learning and/or physical disabilities. There are nine individual houses within the service, each of which has a manager and senior staff team. There are communal resources available to all those living at The Meath including a café, skills centre and gym. At the time of our inspection there were 79 people living at The Meath.

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

People told us they felt safe living at The Meath and appeared comfortable in the company of staff. Training in safeguarding people from potential abuse was completed and staff understood how to report any concerns. Sufficient staff were deployed, and robust recruitment processes were completed to ensure safe recruitment decisions were made. Medicines management systems were in place to support people to receive their medicines in line with their prescriptions. Where errors occurred, systems were reviewed and lessons learnt shared with staff.

Risks to people’s safety were assessed and measures implemented to keep people as safe as possible whilst promoting independence. Accidents and incidents were reviewed, and action taken to minimise the risk of them happening again. Infection control procedures were in place and guidance on how to keep safe during the COVID-19 pandemic followed by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff received training in their roles and told us they were able to request additional training in specific areas when needed. People told us they had choices around what they wanted to eat. Specific dietary needs were known and understood by staff.

There was a positive and open culture within the service. People and their relatives told us staff were kind and caring and communicated well. The management team had recently restructured to enable the service to continue developing team values relevant to the people they supported. Audits and quality assurance surveys were regularly undertaken and any recommended actions completed.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions Safe, Effective and Well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model and size of the service was not in line with current best practice guidance. However, to mitigate this the provider had ensured accommodation was provided within smaller houses/flats. People’s rooms were decorated in a highly personalised way and each house flat had its own individual style. People were involved in making choices and decisions regarding their home and told us they felt listened to. Staff worked in a way which promoted people’s independence.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights. Staff knew people well and people told us their views were respected. Care plans highlighted people’s needs and preferences. People were supported to maintain and develop relationships with those who were important to them.

Right culture:

• The culture of the service focussed on people being at the centre of their support. Staff understood people’s diverse needs which were supported and respected. People took an active part in the local community and community links supported people to gain confidence and independence.

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 3 April 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We completed a targeted inspection of The Meath in September 2020 (published 11 November 2020). We found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service was not changed following the targeted inspection as we did not assess all areas of a key question. At this inspection, we found improvements had been sustained.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The Meath Epilepsy Charity (The Meath) provides accommodation with personal care for up to 84 adults who are living with epilepsy and may have associated learning and/or physical disabilities. There are nine individual houses within the service, each of which has a manager and senior staff team. There are communal resources available to all those living at The Meath including a café, skills centre and gym. At the time of our inspection there were 81 people living at The Meath.

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

People and their relatives told us they felt the service was safe. There was a calm and relaxed atmosphere and people appeared comfortable in the company of staff. Staff were aware of their responsibility to keep people safe and safeguarding concerns were reported and acted upon. Risks to people’s safety were assessed and action taken to minimise risks identified. Medicines and infection prevention and control were managed safely. Sufficient staff were deployed to keep people safe.

People, relatives and staff told us there was a positive culture within the service. Quality assurance processes had been developed to monitor the service people received and ensure improvements were made. Records regarding the care people required and received were completed in a person-centred way.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service had developed strong links with the local community. People were encouraged to access community resources and undertake person centred activities. People received their support from staff who knew their needs well and respected their individual preferences. There was an ethos of personalisation which supported people’s independence.

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 3 April 2019) and there were multiple breaches of regulation. 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

We undertook this targeted inspection to check if the provider had met the requirements of the breaches of regulations identified at our last inspection. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we did not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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.

People’s experience of using this service: People and relatives provided consistently positive feedback regarding the service provided at The Meath. Despite these comments we found some areas of the service required improvement. There was a lack of managerial oversight of the service which had led to inconsistencies in people’s care. Quality audits were not effective in ensuring that people received a safe, effective and well-led service.

Where safeguarding concerns had arisen, these had not consistently been shared with the safeguarding authority or the Care Quality Commission (CQC). There was a lack of consistency regarding how risks to people’s safety and well-being were managed. Records were not always updated as required and some information regarding people’s care was contradictory. Staffing across the service was not centrally monitored. This meant that the management had failed to identify some houses were short staffed on a weekly basis. People’s rights were not fully respected as the principles of the Mental Capacity Act 2005 were not always followed.

People lived in a caring and responsive environment. Staff supported people with kindness and knew people well. There was a relaxed atmosphere with lots of laughter between people and staff. People were encouraged to maintain and develop their independence and there was a positive attitude to risk-taking in some areas. The environment was safe and maintained to a high standard. Each house was homely and people’s rooms were highly personalised.

There was a wide range of activities available to people both within The Meath and in the wider community. There was a clear focus on promoting awareness of people living with epilepsy. The service was committed to maintaining a high community presence and continued to run and take part in a number of local social enterprise schemes. Feedback was sought from people, relatives and staff on a regular basis. The outcomes of surveys were positive and regular compliments were received regarding the service provided.

Rating at last inspection: At the last inspection the service was rated Outstanding (report published on 12 September 2016)

Why we inspected: This was a planned comprehensive inspection based on our previous rating

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. We will check that the provider has made the improvements we identified as necessary through further inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 registered manager supported us during the inspection.

People received excellent care in a way that was personalised and responsive to their needs. There a culture of positive risk taking which enabled people to lead full lives and maximised independence. People were supported by skilled staff who were knowledgeable about their needs and aspirations. Wherever possible, people were encouraged to take control of their own care and were supported in this by relatives and other professionals.

There was a positive and vibrant culture in the service and people were encouraged to push the boundaries and challenge expectations. In addition to a wide range of individual activities people were supported to take part in an extreme sports group which aimed to raise people’s confidence. The service facilitated two social enterprise schemes based on the main high street of the local town. There was a commitment to developing community links and members of the public were invited to participate in various leisure activities with the service.

People’s involvement in the running and development of the service was actively encouraged. People were involved in the recruitment of staff and had begun to contribute to audits of the service by acting as ‘experts by experience’. The service gained regular feedback from people, staff and relatives through an annual questionnaire, house meetings and residents and relative’s forums. The culture of the home was open and people felt confident to express their views and opinions. Concerns and complaints were encouraged, investigated and responded to in a timely manner.

The service worked extensively with other organisation to raise public awareness of people living with epilepsy and was actively involved in on-going research. Local links with other services had been established to ensure good practice was shared. People and relatives spoke highly of the registered manager and other senior managers who acted as positive role models and had a visible presence across the service. Quality assurance processes were robust and action plans to improve the service were prioritised and completed quickly.

People’s healthcare needs were supported in a holistic manner. The on-site healthcare team provided specialist advice and ensured staff were aware of their responsibilities. There were close links with healthcare specialists and appointments were well documented to ensure people’s complex needs were met safely. Medicines were managed safely and staff were knowledgeable about the medicines and support people required in a health emergency.

People were supported to maintain a healthy diet and we saw people were fully involved in choosing their food. Staff were knowledgeable about people’s dietary requirements and where people required support to eat this was provided in a dignified manner which encouraged independence.

There were sufficient staff deployed throughout the service to meet people’s needs. People’s safety was protected as the service had robust recruitment procedures in place and staff were knowledgeable about their responsibilities in identifying and reporting abuse. There were contingency plans in place to ensure people could continue to receive care in the event of an emergency.

Staff received the training and support they required to carry out their roles effectively. Staff undertook a comprehensive induction when they joined the service to enable them to learn about people’s needs and the visions of the service. Progression training was available to staff who wished to further their careers.

We saw that the service had detailed care plans and risk assessments in place to maintain people's safety and welfare. The home was very clean and people helped with this as part of their activities. We saw audits demonstrating that the management was monitoring the quality of service provided.

We found that the recruitment process was thorough and included input from the people who use the service. Staff had a comprehensive training programme and had systems in place to supervise and monitor the standard of their practice.

Ms Simone Jeacock was no longer in post as registered manager and was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. Clarissa Baynes was the registered manager at the time of the inspection.

People we spoke with said they liked living at the service, they could always make their own choices and they enjoyed spending time with their friends, the staff or in their rooms. When we were unable to understand people's communication methods we were able to observe their interactions with us and the staff. Our observations demonstrated that people moved freely around their units and the home. They interacted positively with staff and made choices about every aspect of their daily life and care.

People wanted to show us their rooms which were very individual and contained many personal items. One person had recently chosen new decoration and curtains and their choices had been respected and acted on.

Two people told us they would speak to staff if they were concerned about any aspect of their care. Staff confirmed that they would respond appropriately if people told them about any concerns or complaints. People had opportunities to express their views individually and at meetings and these were acted on.