CQC report explained · a residential care home
What the CQC found at The Meath Epilepsy Charity
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2022
Rated Requires Improvement; inspectors found important gaps in risk monitoring, medicine storage and management oversight.
This was an unannounced, focused inspection on 7 October 2022. Inspectors looked at Safe and Well-led because of concerns about how the risks of sudden unexpected death in epilepsy were managed. They spoke with people, relatives and staff, observed care, and checked care, medicine and management records.
People generally said they felt safe and inspectors saw a relaxed atmosphere. Staff knew people well, and there were enough staff to meet people's needs during the inspection. However, checks on one person's health during sleep were not happening as often as their risk assessment required. Individual epilepsy risk assessments were also not consistently detailed or completed.
Medicines were given as prescribed, but some medicines were not stored safely and storage temperatures were not routinely checked. Staff were also not always wearing masks correctly in shared areas. The home's audits had not found these problems or other safety gaps.
The overall rating changed from Good to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other key questions were not inspected in this visit, so their previous ratings were carried forward.
Positive relationships
People and relatives described a friendly, calm home. Inspectors saw staff spending time with people and supporting activities they enjoyed.
“There was a positive and relaxed atmosphere between people and staff and conversations heard demonstrated staff knew people well.” from the report
Choice and independence
People were involved in everyday decisions and supported to take positive risks and become more independent.
“People continued to be supported to take positive risks in relation to increasing their independence and doing things they enjoyed.” from the report
Medicines given as prescribed
Although storage was unsafe in some areas, records showed medicines were administered as prescribed. Staff also followed instructions for emergency and rescue medicines.
“Records showed people received their medicines in line with their prescriptions.” from the report
Community links
Links with local organisations and specialist epilepsy clinics supported people's access to activities and specialist healthcare.
“Specialist consultants were accommodated to run epilepsy clinics within The Meath.” from the report
Night-time safety checks
seriousOne person's records required checks every 30 minutes, but there were gaps of up to two hours. Contradictory guidance increased the risk that health problems would not be noticed promptly.
“The lack of close monitoring and contradictory guidance put the person at significant risk of their health needs not being identified and acted upon in a timely manner.” from the report
Epilepsy risk assessments
seriousIndividual assessments for sudden unexpected death in epilepsy were not consistently completed or personalised. Staff did not always have the information needed to assess each person's risks.
“People's individual risk of SUDEP had not been screened and risk assessments did not consistently review risks specific to the person.” from the report
Medicine storage
seriousMedicines were not always stored according to guidance, and temperatures were not routinely checked in several houses and flats.
“In addition, the temperature of storage areas were not routinely monitored in a number of the houses/flats to ensure medicines were stored in the right conditions.” from the report
Management checks
seriousAudits and action plans were not thorough or consistently followed up. This meant important safety problems were missed and practice varied between areas of the home.
“The failure to ensure effective and consistent management oversight was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Use of masks
needs fixingStaff did not always wear masks correctly, including in shared areas such as the skills centre and café. The provider said this was due to a misunderstanding of the guidance.
“Staff working and supporting people in the social areas of the service such as the skills centre and café were not consistently wearing masks.” from the report
- 01How have you completed and personalised each person's epilepsy and sudden unexpected death in epilepsy risk assessment?
- 02How do you now check that night-time monitoring happens at the frequency set out in each person's care plan?
- 03How are medicines stored and storage temperatures checked in every house and flat?
- 04What changes have you made to make management audits thorough and consistent across the service?
- 05How do you ensure staff wear PPE correctly in people's homes and shared areas?
This was a focused inspection of Safe and Well-led only; the other key-question ratings were carried forward from the previous inspection. This explanation was written from the published report of 20 December 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2021
Rated Good; inspectors found safe, kind and well-managed care, with some staffing and consent-recording issues to monitor.
Inspectors visited on 11 and 19 August 2021. They spoke with people living at the home, staff and relatives. They observed care and checked care records, medicines records, incident records, infection control systems, training information and quality audits.
The home was rated Good for Safe, Effective and Well-led. People said they felt safe and described staff as kind and caring. Inspectors found that risks, medicines, safeguarding, infection control, staff training and quality checks were generally managed well.
There were some shortfalls. Activities sometimes had to be rearranged because of staff shortages. Induction for some agency staff was not always completed consistently. Consent for some decisions was not always recorded, although the manager provided evidence that this had been addressed after the inspection.
The home had previously been rated Requires Improvement in 2019, with several regulatory breaches. A targeted inspection in 2020 found that the breaches had been resolved. This inspection found that those improvements had been maintained.
People felt safe
People and relatives told inspectors they felt safe. Staff understood how to recognise and report possible abuse.
“People and their relatives told us they felt safe living at The Meath.” from the report
Personalised support
Care was tailored to people's needs, preferences and goals. Staff supported independence and positive risk-taking.
“Care was person-centred and promoted people's dignity, privacy and human rights.” from the report
Good oversight
The home had regular audits and reviewed incidents, medicines and care records. Actions were taken when problems were found.
“Quality assurances processes were in place and regular audits of systems were completed.” from the report
Choice and independence
People were involved in decisions about their homes, activities, food and support. Staff encouraged people to develop their independence.
“Staff worked in a way which promoted people's independence.” from the report
Agency staff induction
needs fixingThe home used agency and bank staff to cover some shifts. Inspectors found that the induction process for new agency staff was not always followed consistently.
“However, during our inspection we found this was not consistently followed.” from the report
Activities affected by staffing
needs fixingPeople's activities and one-to-one sessions sometimes had to be moved or rescheduled because of staff shortages.
“People, relatives and staff told us sufficient staff were deployed to keep people safe although at times people's activities needed to be rescheduled due to shortages.” from the report
Consent records
needs fixingConsent was not consistently recorded for some decisions made by people who had capacity, including the use of audio monitoring equipment. The manager said this had been addressed after the inspection.
“Where people had capacity to make decisions, their consent to decisions including the use of audio monitoring equipment in their rooms was not consistently recorded.” from the report
Size and service model
minorInspectors said the overall model and size of the service did not match current best-practice guidance. The provider used smaller houses and flats to reduce this concern.
“The model and size of the service was not in line with current best practice guidance.” from the report
- 01How often are activities or one-to-one sessions changed because of staffing shortages?
- 02How do you make sure every new agency worker completes the required induction before supporting people?
- 03How do you record people's consent for audio monitoring and other restrictions?
- 04How are the smaller houses and flats used to reduce the concerns about the overall size and model of the service?
- 05What evidence can you show that the improvements made after the 2019 Requires Improvement rating have been maintained?
This was a planned inspection that rated Safe, Effective and Well-led; Caring and Responsive were not rated, and infection prevention and control was also reviewed. This explanation was written from the published report of 7 October 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Meath Epilepsy Charity
4 rated inspections over 6 years: the service has slipped, from Outstanding to Requires improvement.
- December 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2021GoodSafe: GoodWell-led: Good
- November 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedWell-led: Inspected but not rated
- April 2019Requires improvementdown from OutstandingSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- September 2016OutstandingSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Outstanding
- February 2014
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 29 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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