You are here

We are carrying out a review of quality at The Amwell. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 25 November 2020

During an inspection looking at part of the service

About the service

The Amwell is a residential care home providing personal care to 51 people aged 65 and over at the time of the inspection. The service can support up to 88 people.

The Amwell accommodates people in one adapted building split into four floors. At the time of inspection three floors were being used. Each person has their own bedroom with an en-suite bathroom. On each floor there is a shared lounge, dining room with a kitchenette area and bathroom. There is a communal garden, bistro, gym, cinema and salon/spa area for people to access.

People’s experience of using this service and what we found

People were not always safe. At the time of inspection, a COVID-19 outbreak was affecting two of the three floors. Infection prevention and control practices continued to be poor at the service, and staff failed to use Personal Protective Equipment (PPE) in accordance with national government guidance.

People were not always protected from the risk of harm and abuse. Care plans did not reflect people’s needs and risk assessments did not identify or provide guidance on how to mitigate areas of risk.

People did not always receive their medicines safely.

People were not always supported by adequate staffing levels. Staff did not always have the necessary training and experience to safely provide the care people required.

The service was not well-led. The management team had undergone changes but still did not have oversight or awareness of concerns, risks and incidents that had taken place across the service. Quality assurances and processes were not always robust or effective at identifying areas of concern, and improvements to the service were not always made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 10 September 2020).

Following this inspection the service was placed in special measures. We imposed conditions on the provider's registration in August 2020 as they were in breach of the regulations. The provider completed an action plan after this last inspection to show us how they would meet these conditions. A monthly report was sent to CQC detailing progress on medicine administration and auditing processes, staffing levels and review of care plans and equipment. At this inspection not enough improvement had been made or sustained by the provider, therefore the service was still in breach of regulations. The service retains an Inadequate rating.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the COVID-19 outbreak and whistle blowing concerns about neglect and staff failing to use equipment people had been assessed as needing. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Amwell on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-

Inspection carried out on 29 June 2020

During an inspection looking at part of the service

About the service

The Amwell is a residential care home providing personal care to people aged 65 and over. At the time of inspection, the registered manager was not certain about the actual number of people living there. We believe there were 69 people using the service. The service can support up to 88 people.

The Amwell accommodates 69 people (we could not be certain of this number) in one adapted building, separated on four floors. Each person has their own bedroom with an en-suite bathroom. There is a shared lounge, dining room and kitchenette area on each floor. People are also able to access a shared garden, cinema, bistro, gym and salon/spa area.

People’s experience of using this service and what we found

People were not always safe. People were unnecessarily exposed to the risk of Covid-19 because management and staff were not wearing the Personal Protective Equipment (PPE) they were required to. It was identified that the registered manager, management team and staff were complicit in deceiving the inspection team during the inspection site visits about the use of PPE .

People were not consistently protected from the risk of harm and abuse. Risk was not always identified or managed. People did not always receive their medicines in a safe way.

People did not always have their needs met because there were insufficient numbers of staff with the right skills to meet their needs. There was not enough equipment such as hoists and standing aids and this resulted in people having to wait a long time for staff to meet their needs. On one floor there was only one hoist for 12 people who required this equipment for all of their mobility needs.

The service was not well-led. The registered manager did not have oversight of the service. Quality assurance processes were not consistently used and were not robust enough to identify areas of concern.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 20 May 2019).

Why we inspected

We received concerns in relation to the management of pressure wounds, monitoring of weight, monitoring of nutrition and hydration, collaboration with health and social care professionals, the use of PPE and safeguarding adults investigations. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Amwell on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We ha

Inspection carried out on 16 April 2019

During a routine inspection

About the service

The Amwell is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. that offers care and support to 88 older people, some of whom are living with dementia. At the time of the inspection 52 people were living at The Amwell.

People’s experience of using this service

People were happy living at The Amwell. They told us they felt safe and secure. They liked the staff who looked after them. The premises were kept safe and were well maintained.

Staff knew each person well. They knew about people’s likes and dislikes and their preferences about how they wanted to be looked after.

People’s care plans included assessments of risks associated with their care. Staff followed the risk assessments to ensure that people received safe care. Staff knew how to report any concerns about people’s safety and well-being. to and assessments of potential risk ensured that people were as safe as possible.

There were enough staff so that they could meet people’s needs in a timely way. Staff went through a thorough recruitment process so that the provider knew they only employed suitable staff. Staff undertook training that supported them to have the knowledge and skills to do their job well and effectively meet people’s needs.

Staff gave people their prescribed medicines safely. Staff followed good practice guidelines to help prevent the spread of infection. The premises were clean and fresh.

People enjoyed their meals. They had a choice of meals and when to and where to eat them. The kitchen staff cooked a variety of nutritious meals, based on people’s choices and including special diets for those who needed them.

People had access to health services when they needed them. Healthcare professionals supported staff to help people maintain or improve their health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People made choices in all aspects of their lives. Staff respected people’s choices and preferences and people’s views were listened to and acted upon.

Staff respected people’s privacy and dignity and encouraged people to be as independent as possible.

People had use of facilities at The Amwell such as a gymnasium, a cinema and music room. Staff supported people to participate in activities and to follow their hobbies and interests.

The registered manager monitored the quality of care and support people experienced and acted on their feedback.

Lessons were learnt when mistakes were made. Actions were taken to reduce the risk of people experiencing harm.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service as requires improvement (report published on 24 April 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 22 February 2018

During a routine inspection

The Amwell is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service offered support to older people and people who were living with dementia or physical disabilities. At the time of our inspection there were 47 people using the service. The Amwell is a purpose built and set over four floors. There was a communal lounge and dining room on each floor. The Amwell had a gym, a cinema, a bistro and a hairdressing salon available for people to use.

This was the first inspection of The Amwell since its registration with the CQC.

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.

Quality assurance systems were in place to monitor and review the quality of the service which was provided. These had not been used effectively to drive improvement in the service and had not identified the concerns we found.

Risks to people were assessed and monitored regularly. However, the information included in the assessment was not always updated if a person’s needs changed. There was no clear guidance for staff about how to support a person if they became aggressive.

Checks on the environment had not all been completed at the required frequency, however were being updated during our inspection.

People told us they had to wait for support. Staffing levels had been assessed and the registered manager told us they would continue to monitor these. Safe recruitment processes were in place.

Systems were in place to ensure the premises were kept free from infection and hygienic. These were not always followed by staff. There were processes being developed to make sure action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff had not received training and support to carry out their roles. Training was available but staff had not been supported to complete this. Staff had started their employment before they had completed appropriate training.

People were supported to maintain their health and well-being, although the care given to people to show this was not consistently recorded. Where a person was at risk of not eating enough the records of what they had eaten were not regularly completed which appeared to show people had sometimes only had one meal and limited drinks. Staff confirmed people were eating and drinking and this had not been recorded.

People’s needs were assessed and their care was sometimes provided in line with up to date guidance and best practice. The premises and equipment were not fully adapted to meet people’s needs

People usually felt safe when they were receiving care from staff. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

People were supported to take their medicines. There were processes in place which staff followed to make sure people received their medicines safely.

Staff demonstrated a limited understanding of the Mental Capacity Act 2005. They gained people's consent before providing personal care.

People’s private information was not always kept securely to maintain their confidentiality.

People felt they did not receive staff support at times they needed this. They felt they did not always get to know staff due to changes in the staff team.

People were treated with dignity and respect and staff ensured their privacy was maintained. People were sometimes encouraged to make decisions about how their care was provided.

Care plans were not focused on the person