The Meath Epilepsy Charity

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified a continuing breach of legal regulations. The provider did not always follow best practice in line with the Deprivation of Liberty Safeguards code of practice when considering placing certain restrictions on people’s liberty and people were not always supported by robust risk management. We found some risk assessments in relation to management of seizure activity were not in place. However, the provider took immediate action and these are now in place. Management oversight of medicines was not robust. However, people and their family members told us the Meath Epilepsy Centre was a safe environment. Lessons from incidents were learned and people were supported to engage with external healthcare specialists to help them maintain good health. There were sufficient staff to support people safely. Safeguarding procedures protected people from abuse and avoidable harm. Where people required specialised equipment to keep them safe, we saw this was in place and regularly maintained. Staff understood people’s risks and followed their individual risk assessments.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who were able to share their views with us, told us they felt safe. One person told us how the equipment they used was being adapted to make it safer for their use and that it would be “funky” and different from others. Family members told us they were able to raise concerns if they felt something was not right and were confident these would be listened to and acted upon, and told us they were informed of any incidents, “If there was an incident, I would get informed.” One person’s room was in the process of being adapted in response to a previous incident, to ensure they were safe in that environment.

There were opportunities for staff and leaders to learn lessons from incidents and improve outcomes for people. Senior managers told us safety events were reported and investigated and that staff knew who to escalate issues to. Staff we spoke with told us they discussed incidents and accidents to look at what lessons could be learnt, “We are here as a team and do not work in isolation. Whenever something happens, [manager] will call us together and discuss what strategy to use to avoid further occurrence.” Staff understood the importance of reporting concerns to the relevant authorities, in order for information to be shared appropriately. We were told, "I would record [incident] on the system, because if it’s not written it didn't happen.” Staff told us how incidents were discussed in team meetings and any resulting actions and changes to practice was noted in handovers, care plans or daily diaries. One staff member told us, “It is about being transparent because we are not perfect. We learn from that and put in measures to try to prevent things from happening again.” Staff understood the principles of duty of candour and they felt supported by the management team to ensure they were open and honest with people and family members.

The provider had systems and processes in place to seek people’s views, analyse incidents, investigate concerns and learn lessons. There were systems in place to support staff learning from safety incidents during regular meetings. Lessons learned from safety incidents were discussed in staff meetings. The provider responded to family members under the duty of candour which requires registered providers and registered managers to act in an open and transparent way with people receiving care or treatment from them.

People were supported with their health appointments. Records confirmed that people had access to services including GP’s, opticians and dentists. Family members told us they were confident staff understood people’s healthcare needs and supported them to their external appointments with healthcare specialists as required. We were told, “Staff are very vigilant and they have consulted various experts [to review person’s health condition]. They are very prompt in addressing what they need to do, I have no concerns,” and “I get very good feedback from the staff team following GP visit, which I really appreciate, the communication is brilliant.” Family members told us they were part of their relative's care planning meetings, “I do have discussions about care planning and there have been things to fill out asking what my opinions are, and I get a weekly report which is helpful.”

Staff had an awareness of the risks to people relating to their health and care. Senior staff made regular referrals to health and social care services and supported people to attend meetings with healthcare professionals. Staff told us, “We will always call the GP, we also have a list like a flow chart that we have to follow in line with policy. This ensures we take the right action and there is no block or delay in getting people the right care. Others told us, “If we go with people to their specialist appointments, we take along medicine administration records and all notes to ensure we are giving the most up to date information.”

A healthcare professional told us staff contacted them in a timely manner to inform them of changing needs and to seek advice. They also said staff kept them updated on any progress or deterioration. Feedback from a healthcare professional included, ‘‘The more recent appointment of a nurse with specialist knowledge in epilepsy has helped to reduce our level of input. Communication has become more stream-lined with the nurse at the Meath communicating directly with the neurologist at [hospital].’ Another told us, “Staff responded well when we guided them to contact us more promptly regarding changes in their client presentation. Communication with the staff team is very effective, mainly via email but they request phone calls when issues are more complex so we can talk through.”

There were systems and pathways in place for staff to be able to work with healthcare professionals and ensure continuity of care for people. Staff told us they supported people with their medical and healthcare appointments, and said there was easy access to the GP, who spent a day on site each week, and was also available in their surgery at other times. People had hospital passports to ensure there was current information available to hospital staff about a person's needs such as, medication, personal details and their preferred method of communication.

The provider did not always follow best practice in line with the Deprivation of Liberty Safeguards code of practice when considering certain restrictions on people’s liberty. Where restrictions were placed on 5 people’s liberty to keep them safe, we confirmed with the registered manager that no assessment of the person’s capacity was made, or Best Interest decision meetings held, to consider making a DoLS application to the local authority within the requirements of the Mental Capacity Act 2005. It is acknowledged there had been no impact to the person and appropriate documentation was put in place following our feedback. We have considered these failings in the Governance, management and sustainability part of this assessment report. People were safe and protected from harm. Family members told us they had no concerns about their relative’s safety and told us staff knew people well and they observed friendly interactions. One told us, “[Family member] is really safe there and I feel that the service is very much on the up,” and “Yes, they are totally safe. Staff are very understanding and I know [person] is safe and happy.”

Staff told us they received safeguarding training and were able to explain their responsibilities with regard to raising concerns. One staff member said, “We always investigate and this will be followed up by managers. Nothing is ever left and we need to learn from it.” Others said, “It is important to recognise when things are going wrong so it can be sorted out in time. For example, if someone has a bruise we have to escalate it [to registered manager] or our seniors.” A senior member of staff told us, “There has been a big drive with safeguarding and this helps staff to be more comfortable in their knowledge. It helps them to understand that raising a safeguarding is not something to be worried about, it demonstrates all our commitment to keeping people safe.”

We observed people appeared confident when engaging with staff and seeking their support.

The provider did not consistently follow Deprivation of Liberty Safeguards processes. However, there was a strengthened focus to make safeguarding a collective responsibility. This included setting up a safeguarding working group, which we were told considered current or recurring safeguarding matters. A senior member of staff told us, “We are also looking at how we can work with residents to enable them to understand safeguarding and how they can speak up.” We saw folders with Easy Read guidance for people about how to speak up and what the safeguarding process entailed. There were safeguarding folders for staff to use as a quick reference to refresh their understanding of safeguarding processes.

People were not always supported by robust risk management. For example, we found some risk assessments in relation to management of seizure activity were not available for inspectors to view on the assessment day as staff were unable to locate them. It is acknowledged there was no impact to the person and the provider assured CQC these were in place following this assessment. Where risks to people were assessed, risk management plans considered safe staffing requirements as well as the environment, equipment, and behaviour. This enabled people to be safe in their own home and to engage in activities they enjoyed. People we spoke with told us they felt safe and liked the staff supporting them. Family members told us, “The Meath have waking staff and they have an alarm so when [service user] leaves the bedroom, staff can check they are safe.” Others said, “Staff have done the risk assessments and do not let [service user’s] illness restrict their life.”

Staff knew people well and had a good understanding of their needs, including some of the restrictions placed on people. We were told, “One person loves to cook so we support them to do this, as well as making sure the environment is safe so that they cannot injure themselves if they have a seizure. We look out for the preliminary signs of a seizure and can quickly intervene.” Staff understood the need to support people to manage risk safely, whilst ensuring they were not disproportionately restricting them. They said, “It is a balance between people’s safety and making sure we are supporting people to be as independent as possible,” and “It is all about analysing and anticipating. It is very important to promote independence so that they can live a normal life alongside of their disabilities.” A healthcare professional told us,” We provided more guidance regarding seizure types following telemetry to identify seizure types, which the staff took on board. They contact us if they are unsure about their client's presentation and need advice.”

It was clear from our observations that staff had developed good relationships with the people they were supporting. Some restrictions were in place such as window restrictors and keypads. These restrictions were lawful and kept people safe from avoidable harm. For some people keypads did not restrict their freedom of movement as they were able to use them independently. On both our visits to the Meath Epilepsy Charity, we observed people moving around all areas independently or where necessary, facilitated by staff to do so.

The provider’s systems and processes to ensure certain risks to people were assessed, managed and mitigated safely were not always consistently applied. In other areas, there was an overall understanding of risk and people had risk assessments in place related to their individual needs.

People’s environments had been adapted to keep them safe and they were able to freely move around the Meath Epilepsy Charity and access all areas inside individual buildings and around the site in general. People told us they were excited about the recently renovated kitchen in one of the houses, “We were able to choose things for it, which was really fun, we liked it.” Family members told us the environment was accessible for people, “The staff are always very responsive [to access issues] and it is usually something they have already thought about” and “The home is accessible to [person], there is a lift which gives access to all activities in the skills centre as well as being able to go to the Hive for food.” Others told us, “[Person’s] room is in the old part of the house and whilst it is a bit confined, if you ask [person] if they are happy with it, they say, oh yes I love my room, I love living at the Meath.”

Staff told us there had been a programme of building improvements in many areas of the Meath Epilepsy Charity over the past 18 months. They also told us there was a greater emphasis on fire safety with unannounced drills taking place regularly.

The environment had been modified in line with people’s risk assessments to keep them safe. People’s bedrooms were personalised to their taste and some areas were recently refurbished.

The provider had reliable and robust systems and processes in place to ensure the environment was safe and well maintained. The Surrey Fire and Rescue service made certain recommendations to enhance fire safety in some of the houses in their most recent fire safety assessment report which were addressed by the provider. Fire, health and safety checks and drills were routinely completed and the on-site maintenance team responded in a timely manner to any logged repair requests.

There were enough staff to support people well. People were supported by a consistent team of skilled staff who knew people, their needs, and preferences. One person told us, “Staff were nice and I joke with them. I just ask them when I need anything." Family members told us staffing ratios were generally maintained and staff skills matched people’s needs. One said, “The Meath is great, [person] has never been healthier and more occupied than since being here. I am struck that it has always been same staff and even [the same] agency. It has a very good feel between staff and resident and matching people who they are compatible with.” Another said, “There seems to be an appropriate skill mix in the staff team; some of the newer staff need to be upskilled but as long as there is senior or manager on shift it is fine,” and “Staff are attuned to the needs of the residents and I’ve always seen positive interactions with the residents and guests who visit.”

Staff told us there were enough staff to provide safe care, and told us they tended to cover gaps in the rota to minimise the need for agency staff. They said, “We very rarely need to use agency. We support new staff and they ‘shadow’ experienced staff for as long as it takes to make them feel confident and competent.” Staff told us where a person needed one to one support from a staff member, “The one to one staff are rotated to ensure a range of staff are competent to support that individual.”

Staff we spoke with were generally positive about the training available to them as well as their induction which was, “Very detailed and person centred.” One person said, “Training has been very good, I am new to this work environment and everyone has been so helpful and generous with their time which made it easy to fit in and enjoy my work.” Some said they would welcome specialist training to reflect people’s changing needs, “It would be helpful to have a specialist training course on how to better support someone with dementia. Some people have lived here for a long time and have developed signs of dementia. I think if we knew how to do things differently with some people they would have better support.” Staff also told us they received supervision, appraisal and support to develop, “I have regular supervisions where I can discuss actions I was tasked with. I am always asked whether I want to do any development and am encouraged [by senior staff] to develop in directions that are of interest to me.” Another told us, “Supervision helps me to explore areas for improvement and gives me an understanding of providing the best care to people. We set objectives and then discuss them during the next supervision and also at my annual appraisal.”

Throughout our assessment there appeared to be sufficient staff around to meet people’s needs safely and promptly. Staffing levels reflected the planned rota. There were sufficient staff to support people at lunchtime and the atmosphere was relaxed. There was no indication staff felt rushed and were seen socialising with people. We observed one person using their preferred method of communication. We were told that some staff were not yet trained in this communication method, but there was an onsite trainer who was aware that this needed to be extended to all staff, and was a work in progress.

The provider ensured there were safe employment processes in place to protect people from the recruitment of unsuitable staff. References were obtained and appropriate checks were made to ensure staff were safe to work with people and authorised to work in the UK. The rota reflected safe staffing ratios were consistently maintained. Policies related to recruitment, induction, training, supervision and appraisal were regularly reviewed. Oversight of staff training was maintained centrally by the human resources department, with alerts sent to managers in the event of any training being overdue. There was a comprehensive programme of training to ensure staff had the skills and knowledge to undertake their role. Since the last inspection in October 2022, the Meath Epilepsy Charity recruited an epilepsy nurse specialist who told us part of their remit was to ensure staff had the skills, knowledge and competency to support people with their epilepsy. This included “Bite sized epilepsy training and delivering bespoke workshops related to individual healthcare needs.”

People were protected from the risk of infection because premises and equipment were kept clean and hygienic and were supported by staff who followed infection, prevention, and control (IPC) processes. Family members told us the environment was clean and well maintained, “It’s always clean, they seem to have good cleaning staff, everything is kept nicely.’’ “The unit is clean and well maintained and that includes the bedroom. Staff are very keen to maintain a clean environment. I think the place is immaculate.’’

Staff told us they had received training in food hygiene and IPC. They were knowledgeable about how to prevent the spread of infections and the need to use personal protective equipment (PPE) which they said was readily available to them. The registered managers knew what to do in an infection outbreak and had cause to initiate COVID-19 protocols during a recent infection and said, “We were very confident and comfortable in managing this, and believe we contained the spread.”

We found the home to be clean overall and there were no odours and observed housekeeping staff cleaning bathrooms and communal areas. We saw staff were able to access aprons and gloves and these were used appropriately throughout our visits. Staff encouraged and assisted people with hand hygiene appropriately, for example after using the toilet and prior to meals.

There was a current infection prevention and control (IPC) policy, which included staff training and IPC audits. Staff received training in IPC and food hygiene. Audits were carried out to check and confirm IPC measures within the home were satisfactory.

The provider did not ensure there were safe systems in place for the appropriate and safe handling of medicines. For example, medicine administration records (MAR) did not always have clear dosage instructions which could lead to errors while giving medicines. Handwritten MARs were not consistently checked and signed by a second member of staff as per guidance. We found an out of date homely (over the counter) medicine was being used beyond the manufacturer’s specification for effectiveness. It is acknowledged there had been no impact to the person and appropriate documentation and systems were put in place following our feedback. We have considered these failings in the Governance, management and sustainability part of this assessment report. One person told us staff assisted them with their medicines. Family members told us they had no concerns about how staff administered medicines, ‘’Yes, medicines are given in a timely way, I have witnessed that. It hasn't been reported if there have been any missed medicines and I wouldn’t expect to know,’’ and “I have no concerns about how [person’s] epilepsy medicine is managed; there has been only one occasion when they were not given at the right time, it was a one off issue, and the manager phoned up and apologised for this.”

Staff received training over a 6 week induction period before being assessed as competent to manage medicines safely. Staff told us medicines errors were viewed seriously and would result in them being removed from administering medicines until the matter was investigated and they were retrained and subsequently signed off as competent by a senior member of staff. Although comments from staff were positive, due to the concerns found with medicines we could not be assured staff followed guidance. A healthcare professional told us staff followed their guidance with respect to medication titration and recognising side effects and seizures. They also told us staff gave them timely notice when prescriptions for specialist medicines were required.

The provider carried out regular medicines audits though these failed to identify concerns found during the assessment. Staff were not consistently following the provider’s policies and procedures for the safe management of medicines, including administration and recording. Audits did not identify that staff did not always monitor and record the minimum and maximum temperatures of medicine refrigerators. We saw that the GP regularly reviewed people’s medicines. We found that some staff were not aware of the principles of ‘Stopping over medication of people with a learning disability and autistic people’ (STOMP), which is a national NHS England work programme to stop the inappropriate prescribing and use of psychotropic medications.