About the service: The Meath Epilepsy Charity is registered to provide 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 eight 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: 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 inspection took place on 22 June 2016 and was unannounced. The Meath Epilepsy Trust is registered to provide 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 eight 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.

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

We spoke with and listened to people who use the service and most of these people were able to express their opinions through speech, gesture or sound.

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.

People who use the service appeared relaxed with the staff. The whole location had a vibrant, caring and positive atmosphere. We observed people being assisted in a respectful manner. Those who required extra assistance were helped in a manner that promoted their dignity and independence. People told us that “they help me to be me”, “I’m very happy here, there’s so much to do” and “I never want to leave. The staff make my life so much more fun than before”. We spoke with relatives of people at the service who told us that they were involved in all discussions about care and were confident that their loved ones were safe.

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.