The Meath Epilepsy Charity

Updated 20 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors

Service and service type

The Meath Epilepsy Charity (The Meath) is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Meath is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were four registered managers in post. The service had chosen to register additional registered managers due to the size and complexities of the service.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we had received about the service since our last inspection. This included meetings we had held with the service and action plans provided. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with seven people who used the service and gained feedback from six relatives about their experience of the care provided. We spent time observing people’s care. We spoke with 15 members of staff including two of the registered managers, the quality assurance manager and members of the care team.

We reviewed a range of records. This included seventeen people’s care records and medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including audits and surveys were reviewed.

Updated 20 December 2022

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.