The Meath Epilepsy Charity

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified a continuing breach of legal regulations in relation to the systems in place for governance processes and audit.

There had been a failure, since the last inspection, to improve the shortfalls identified in medicines management. New issues were also identified during this assessment in relation to Deprivation of Liberty Safeguards and risk management. These shortfalls were corrected post inspection. There have been recent additions to the senior leadership team, including a head of care, compliance manager and nurse specialist in epilepsy. They have demonstrated skills and commitment to ensuring service improvement and understood the need for consistent improvement. We observed relaxed and positive engagements between staff and those who lived at the Meath Epilepsy Charity. Staff told us the management team were hardworking and approachable. They felt able to speak up or to whistle blow if required and there was an open-door culture where staff felt able to access support when they needed it. There was partnership working with families, professionals, and other organisations.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff knew what processes supported them to raise concerns within their organisation and with partners agencies. Those whom we spoke with told us they felt able to speak up and were aware of the whistleblowing policy. They said they could speak with managers and members of the senior leadership team to raise issues and they demonstrated a good understanding about how to raise any concerns they had. We were told, “I know that if I have concerns that I will be able to whistle blow. I know the steps which I can take,” and “I know how to whistle blow, we have access to the number it’s always shared with us and we are always reminded by managers about our responsibilities to speak up if we are worried or have concerns.”

Processes were in place to enable staff the opportunity to speak up. The provider’s whistleblowing policy outlined protection for the whistle blower and the support and protection from reprisal if they were to raise a concern. Staff knew how to raise concerns to CQC and other organisations. Regular staff meetings, supervision sessions and appraisal also provided staff with the opportunity to speak up. A senior member of staff told us, “I think we promote an open culture where staff can come forward if they have concerns.”

The provider valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them. Staff told us their individuality was supported by the organisation and they were treated fairly, “I think Meath recognises my culture and I achieve and develop according to my abilities” and “We are quite diverse here and we support each other, culture and religions are respected.” Staff told us the provider adjusted their work shift pattern and the number of hours they worked to accommodate commitments in their personal lives.

Staff received recognition through provider bulletins and systems were in place to commend staff considered to have made a contribution to improve service delivery. The human resources department published a monthly newsletter which updated staff on recent promotions, training courses and introduced new staff. Member of this team also ensured staff had access to ‘ mental health first aid’ and ran a weekly open door session for staff to raise any work-related queries.

Staff told us they knew their roles and responsibilities and felt supported by the management team to fulfil their accountabilities. Staff told us they were held accountable by the management team and that the management team reiterated areas of improvement until these had improved sufficiently. We were told, “We do audits on each unit and individual staff have audit responsibility for different areas, for example, medicines,” and “There is soon to be a new system which will be more visual and this will help staff to understand progress and direction.” However, audits had not identified or recognised the shortfalls found on assessment.

The provider's processes for quality assurance and audit were not robustly applied since they had not identified the shortfalls found by inspectors during our assessment. We saw how staff and managers completed regular audits and quality checks of the service, but these were not sufficient to ensure people were adequately protected from the risk of receiving unsafe care. Quality assurance processes were inconsistent. The provider’s checks and audits failed to identify that risk assessments specific to 3 people’s healthcare needs were not in place. They did not identify that documentation related to the deprivation of 5 people’s liberty was missing. Medicines audits failed to identify shortfalls in medicines management and storage. A senior member of staff told us, “There is work in progress to change from the current methodology of paper based audits being submitted from each unit. In future, these will be electronic and will be received by quality assurance lead in real time so changes can be made centrally.” They said the new process would enable better oversight of all audits and therefore quickly identity areas for improvement. They also told us, “Audits by senior leaders and trustees are in the process of being changed to look at quality with ‘I and We’ statements and are designed to be resident led. I am conscious that a number of audits are quantitative rather than qualitative." There was a business continuity plan in place to ensure the safe and continued running of the service in the eventuality of a serious and significant unplanned event.

People used community services and facilities and participated in community based activities. People accessed local health facilities and professionals for medical treatment.

A member of staff told us, “I think we work well with various doctors, consultants and social workers to make sure everyone speaks to everyone and we always share information on any changes with anyone that needs to know.” There was engagement with a charitable group of retired engineers who were working on a project to adapt a wheelchair for greater safety.

Feedback received informed us the service worked in partnership with health and social care professionals. The GP informed us that the staff are caring and know the SU's well. Feedback from a healthcare professional included, ‘The service works well in partnership with [hospital] and with the GP. This has helped our communication with the GP to ensure medication changes are timely.’

The service worked in partnership with other agencies. These included healthcare services as well as local community resources. Records showed that staff engaged with a variety of health and social care professionals.

The provider promoted a culture of learning, and they understood their responsibility to be open in the event of anything going wrong. There was a meeting held every 2 weeks to discuss potential learning from incidents. Staff told us a safeguarding and sexual education group was recently set up, not only to increase staff learning, but also to support service users to recognise unsafe and unacceptable behaviour in others and to have the confidence to report it. However, some of the staff whom we spoke with had responsibilities in the areas where we found shortfalls, which meant learning and improvements were not always embedded into day to day practice.

We identified some areas where improvements in learning were not sustained since the time of the last inspection in October 2022. These included certain aspects of risk management, oversight of medicines and effective auditing. Systems and processes to support learning and improvement did not consistently identify areas for improvement, including medicines and risk management. However, the provider supported stakeholder surveys and meetings which provided service users, family members and staff with an opportunity to provide feedback about the service and their experiences. These were used to drive service improvements. A family member told us, “I haven’t been to recent meetings, though meetings in the past have been good, and they do seem to listen to what the parents have to say.’'