The National Centre for Young People with Epilepsy provides specialist education and residential provision for children and young people with neurological conditions, learning and physical disabilities. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Up to 110 young people can be accommodated across the provision for further education. There are 15 houses, with between six to 12 young people living in each house. At the time of the inspection 84 people were living in the houses.

At the last inspection on 21 July 2015 the service was rated ‘Good.’ At this inspection we found the service remained ‘Good.’ At a focus inspection on the 3 March 2017 we made a recommendation that the registered manager ensures that staff are aware of the times and needs of a person and when they require one to one support. During this inspection we found that the registered manager had actioned this recommendation. Staff were aware of which people required one to one support.

There was a registered manager in place. 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.

People told us they felt safe living at the service and that staff treated them well. Staff were aware of the procedures to follow if they had any suspicions or witnessed abuse. There was a safeguarding lead person who monitored safeguarding at the service and was available throughout the day to people, staff, relatives and visitors. Risks had been identified and assessed for each person to help keep them safe and to live their lives as independently as possible. There was sufficient staff deployed to attend to the needs of people. Medicines were managed in a safe way and the recording of medicines was completed to show people had received the medicines they required. A thorough recruitment process was in place to ensure only suitable staff were employed at the service.

Staff continued to receive training, regular supervision (one to one meeting) and annual appraisals that helped them to perform their duties. Staff understood the Mental Capacity Act 2005 (MCA) principles. Staff had followed the legal requirements of the MCA where restrictions were in place. Staff supported people to eat a variety of freshly prepared foods. People had access to all internal and external healthcare professionals and their involvement was sought by staff to help maintain people’s good health.

Staff respected people’s privacy and dignity and involved them in making decisions about their care. People were able to choose how they spent their time and could freely access all communal areas of the service. People’s relatives and visitors were welcomed and there were no restrictions of times to visit.

Documentation that enabled staff to support people and to record the care they had received was up to date and continued to be regularly reviewed. People and their relatives were involved in the reviewing of their care. People took part in a variety of activities that interested them. A complaints procedure was available to people, relatives and visitors. Complaints received had been resolved in accordance with provider’s complaints policy.

There was a positive culture within the homes, between the people that lived there and the staff. People told us that they could talk to staff and they would always listen to them.

The provider had an effective system in place to monitor the quality of care and treatment provided in each of the homes. Staff were asked for their views about how the service was run during staff and daily handover meetings. People and their relatives continued to be involved in the running of the service and their feedback was sought. Staff told us that t

Young Epilepsy formerly (The National Centre for Young People with Epilepsy) is a specialist college situated on the outskirts of Lingfield village. Young Epilepsy provides specialist education and residential provision for children and young people with neurological conditions, learning and physical disabilities. Around 60-65% of the students receiving care had a primary diagnosis of epilepsy and other students had autistic spectrum disorders and neurological conditions without epilepsy.

Up to 110 young people can be accommodated across the provision for further education. There are 15 houses, with between four to 12 young people living in each house. Around 85% of people live on site. Some people go home for the school holidays whilst others stay on site for 52 weeks of the year. Five of the houses have people that stay 52 weeks of the year. At the time of the inspection 108 people were living in the houses.

The age range of students is 18 - 25 within the college provision. There is also the Neville Childhood Epilepsy Centre (NCEC) which supports the assessment and diagnosis of up to 12 children from the age of two years old. There is a residential school for children and young people which is regulated by Ofsted. Ofsted is the Office for Standards in Education, Children’s Services and Skills. They inspect and regulate services that care for children and young people, and services providing education and skills for learners of all ages.

There was a registered manager in post. 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 was only responsible for the regulated activity of accommodation for persons who require nursing or personal care. The nurse manager is in the process of applying to register with CQC for the regulated activity of treatment of disorder disease and injury (TDDI) and diagnostic and screening procedures.

We carried out an unannounced comprehensive inspection of this service on 20 and 21 July 2015. At this inspection, a breach of legal requirements in relation to staffing was found. After the inspection, the registered manager wrote to us to say what they would do to meet the legal requirements in relation to the breach of staff deployment.

We undertook this focused and responsive inspection to check that they had followed their plan and to confirm that they now met legal requirements. We also had concerns bought to our attention that staffing deployment continued to be an issue, there had been a high number of incidents and accidents and the management of risks for people was not always safe. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

While improvements had been made, there was still some work to be done. We saw that sufficient action had been taken to meet the legal requirements.

There were improvements with staff deployment. There were enough staff to keep people safe. However, sometimes people missed out on activities off campus as there were not always enough staff. Some staff were confused as to whom needed one to one support. We have made a recommendation about this.

Risks to people were identified and managed appropriately. Staff were aware of individual risks and how to keep people safe. Staff had detailed risk assessments and the right training to keep people safe who became distressed or anxious.

People were protected from avoidable harm. Staff understood and recognised what abuse was and knew how to report it if this was required. However, they were not always aware of external agencies they could contact

The provider told us they carefully assessed the care and support needs of students living in the homes. All the students, their relatives, representatives and health care professionals, where necessary were involved in this process. The arrangements for supporting students to make decisions about their daily lives and preferences were recorded in their care plans.

We spoke to two relatives and five students who used the centre. One student told us that they enjoyed being at the centre. Two other students told us that their experience of the centre was good. One relative said, “Our son is always happy to come to the centre and his routine was adapted to his needs”. Another relative said, “My daughter is always treated extremely well, with dignity and respect”.

There were effective systems in place to reduce the risk and spread of infection.

There were effective recruitment and selection processes in place.

People had their comments and complaints listened to and acted upon without the fear that they would be discriminated against for making a complaint. One person told us, “I know who to go to if I am unhappy about something”.

We spoke to fourteen young people who use the service in four different houses across the centre. All those who were able to give their views spoke positively and said they were happy living there. Ten young people told us they were supported to be independent and were able to make their own choices, such as how to spend their free time.

Young people using the service told us of the wide range of social and leisure activities they are able to take part in, as well as their involvement in running their own house.

Young people using the service told us they had been involved in their student management plans, felt well supported by their key-workers and knew who to speak to if they had any concerns or were worried about anything.

Young Epilepsy formerly (The National Centre for Young People with Epilepsy) is a specialist college situated on the outskirts of Lingfield village. Young Epilepsy provides specialist education and residential provision for children and young students with neurological conditions, learning and physical disabilities. Around 60-65% of the students receiving care had a primary diagnosis of epilepsy and other students had Autistic Spectrum Disorders and neurological conditions without epilepsy.

Up to one hundred and ten young students can be accommodated across the provision for further education. There are sixteen houses, with between six to nine young students living in each house. Around 85% of students live on site. Some students go home for the school holidays and some students stay on site for 52 weeks of the year. Five of the houses have students that stay 52 weeks of the year.

Students have their own rooms within each house which they are encouraged to decorate themselves. Life skills are taught in each house helping students to grow in confidence and develop their independence.

The age range of students is 18 - 25 within the college provision. There is also the Neville Childhood Epilepsy Centre (NCEC) which supports the assessment and diagnosis of up to 12 children from the age of 2 years old at present the provider is registering this service with the Care Quality Commission.

There is a residential school for children and young people which is regulated by Ofsted. Ofsted is the Office for Standards in Education, Children’s Services and Skills. They inspect and regulate services that care for children and young people, and services providing education and skills for learners of all ages.

Our inspection took place on 20 and 21 July and was unannounced. We asked for a specialist pharmacy inspection which was also unannounced and undertaken on the 13 August 2015.

The service was run by a registered manager, who was present on the day of the inspection visit. ‘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 and associated Regulations about how the service is run. Each house had a House Manager (HM) although each HM was responsible for two houses.

Care was not provided to students by a sufficient number of qualified staff throughout the school holiday period. The service stated that they were short of assessed care staff numbers.

Staff were appropriately trained. Students did not have to wait to be assisted.

Staff had written information about risks to students and how to manage these. We found the registered manager and house managers considered additional risks to students in relation to community activities, seizure activity and these changes had been reflected in students’ support plans.

The service was creative in the way it involved and worked with students, respected their diverse needs, and challenged discrimination. The service sought ways to continually improve and puts changes into practice; for example students were involved in how they developed through the service provision.

Staff had received training in safeguarding and were able to evidence to us they knew the procedures to follow should they have any concerns. Staff members said they would report any concerns to the registered manager or the safeguarding lead within the college. They knew of types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Students who may harm themselves or displayed behaviour that challenged others had shown a reduction of incidents since being at the service and students who required one to one support were provided with this to help meet their individual needs.

Processes were in place in relation to medicines. All of the medicines were administered and disposed of in a safe way. Staff were trained in the safe administration and the administration of specialist medicines for treating seizures and they kept relevant records that were accurate.

The Care Quality commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLs and what they needed to do should someone lack capacity or need to be restricted.

Students were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer students snacks at any time during the day or night within the separate houses. Staff promoted healthy lifestyle programmes for students and supported their abilities to make choices, be independent and receive the level of support they need to eat, drink and prepare meals. Which adheres to the key outcomes of Health and Wellbeing identified in the Children’s and Families Act 2014 where a healthy lifestyles learning programme are a key part of college curricula.

Students were treated with kindness, compassion and respect. Staff took time to speak with the students who they supported. We observed positive interactions and it was evident students enjoyed talking to staff. Students were able to see their friends and families as they wanted and there were no restrictions on when students could visit the home.

Students were at the heart of the service; and took part in a wide range of community activities on a daily basis; for example trips to the shops, and attending college which is on site. The choice of activities was specific an innovative to each person and had been identified through the assessment process and the regular house meetings held.

Students placed at the college after 1 September 2014 should have an Education, Health and Care Plan (EHCP), which should describe their aspirations and support needs. The colleges EHCP programmes reflected students’ individual outcomes in the areas of employment, living more independently, participating in the community and in health and wellbeing.

Students had an individual support plans, detailing the support they needed and how they wanted this to be provided. This included the provision of further education, social support and physical needs support. Students had ‘learner contracts’ that described college expectations, student codes of conduct and the ‘learner voice’, which gave students the opportunity to express their views and exercise choice and control.

Students were expected to participate in their formal learning programme, for example, by attending lessons, or work experience. They had more choice about activities at other times but were encouraged to maximise the opportunities that the college offered.

We read in the support plans that staff ensured students had access to healthcare professionals when they needed. For example, the doctor, learning disablement team or the optician. The service had a multitude of specialists employed which also included Epilepsy specialist nurses, pharmacist, behaviour specialist , doctors, consultants and occupational therapists which ensured all health and social needs of students were met.

Students received consistent, planned, coordinated care and support when they used or moved between different services within the college and eventually from the college to either living independently or supported living. There were 12 students on the ‘Connect2’ programme which provided continuing care, accommodation and activities to older students; without the education element. This programme is to support people moving to external services.

Staff had the skills to support students to develop and direct their own care, make mistakes and take risks. Staff understood and supported students to use assistive technology for communication and to promote students’ independence/autonomy.

Students’ care had been planned and this was regularly reviewed with their or their relative’s involvement. A relative told us, “We do feel involved”. The registered manager told us, “It is vital to know the whole person and to talk with all the students who know them, their likes and dislikes, so we can connect with them.”

The registered manager told us how they were involved in the day to day running of the service and delegated other management tasks to the senior management team. It was clear from our observation that the managers new the student’s very well and that students looked at them as a person to trust. Staff felt valued and inspired under the leadership of the registered manager. The senior leadership team included the head of care, and ensured that the ethos and practice were consistent across the whole of the college, from the learning environment to the care and support provided to students who lived in the residential accommodation.

The college sought ways to continually improve and puts changes into practice and sustains them.

The had a robust system of auditing processes in place to regularly assess and monitor the quality of the service or manage risks to students in carrying out the regulated activity. The registered manager had assessed incidents and accidents, staff recruitment practices, care and support documentation, medicines and decided if any actions were required to make sure improvements to practice were being made.

The registered manager kept up to date with any changes in legislation that may affect the service, and participated in monthly forums where good practice was discussed. They pro-actively researched specialised publications and websites to identify innovative ways to enhance students’ quality of life and introduced these to the service and to promote to wider communities accepting and de stigmatizing epilepsy and people with complex disabilities. The registered manager told us of projects they were currently involved in; for example a television programme called ‘ Epilepsy and Me.’

The service notified the Care Quality Commission of any significant events that affected students and the service and promoted a good relationship with stakeholders.

Staff were recruited following robust procedures. The College employed diverse groups of staff, from teachers, learning support assistants (LSAs), care staff, therapists, nursing and medical staff, administrative staff and estate management teams. Some staff had dual roles, for example, as LSAs in the classroom and care staff in residences.

Complaint procedures were up to date and students and relatives told us they would know how to make a complaint. Confidential and procedural documents were stored safely and updated in a timely manner.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep students safe.

Students’ views were obtained by holding meetings and sending out an annual satisfaction survey which staff supported students to complete using different methods of communication.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.