The Amwell

The Amwell is a residential care home providing personal care to up to 88 people. The service provides support to people aged 65 years old and older living with physical disabilities and conditions such as dementia. At the time of our inspection there were 48 people using the service.

The Amwell is a purpose-built building supporting people across 3 floors. There are communal spaces such as a bistro, salon, gym, cinema and garden. All people living at the service were supported to access these spaces. People had their own bedrooms with en-suite bathrooms, and each floor had shared dining rooms and lounge areas.

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

People were safeguarded from the risk of harm and abuse. Staff were knowledgeable about safeguarding matters and knew the procedure to report any concerns. Where incidents had occurred, these were investigated and referred to the local authority.

People’s care needs were assessed and where needs changed; care records were updated. Risks for people were identified and assessed thoroughly. Staff followed guidance and had received training to safely meet the care needs of people in the service.

People received medicines safely and staff were trained in how to administer medicines.

Staff were trained and there were enough staff available to meet people’s care needs.

The service was well-led. Systems and processes were in place to allow oversight of the service. The registered manager was absent during the inspection however there was an effective, stable management team in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported 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 6 August 2022).

Why we inspected

We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Amwell is a residential care home providing regulated activity of personal and nursing care to up to 88 people. The service provides support to people aged over 65 years old living with physical disabilities and conditions such as Dementia. At the time of our inspection there were 45 people using the service.

The Amwell is a purpose-built building supporting people across three floors. There is a shared bistro, gym, salon, cinema and garden all people living at the service are able to access.

Each person has their own bedroom and en-suite bathroom. Each floor has a communal dining room and lounge areas.

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

People were safeguarded from the risk of harm abuse. Staff understood safeguarding concerns, and any incidents were investigated and referred to the local authority.

People’s care needs and risks were assessed. Staff followed guidance available advising how to safely meet people’s care needs.

People received medicines safely and staff were trained in how to administer medicines.

Staff were trained and there were staff available to meet people’s care needs.

The service was well-led. Systems and processes were well established and embedded which allowed the registered manager to have oversight.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported 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 requires improvement (published 17 June 2021).

Why we inspected

We received concerns in relation to how people were cared for. There was also a COVID-19 outbreak at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Amwell is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 88 people.

The Amwell provides support to people in one adapted building on three floors. Each person has their own bedroom and ensuite bathroom. Each floor has a communal dining room and lounge area. At the time of inspection only two of the floors were being used.

The Amwell has a shared bistro, gym, salon, cinema and garden all people living at the service are able to access.

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

Improvements to the service had been made but it was too early to determine if improvements could be sustained. This was due to the introduction of a new manager.

People’s needs were more consistently identified, care planned, and risk assessed. Safeguarding concerns and incidents were better identified, and steps were now being taken to mitigate risk.

Staffing levels had been reviewed and people were now supported on two floors rather than three. This meant staff were more responsive to people’s needs and could provide care and support in a timely manner.

Improvements to how the service was led and governed had been made. Processes and systems were in place to identify areas of improvement; however these had not been fully embedded at the time of inspection.

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 Inadequate (published 20 January 2021) and there were multiple breaches of regulation.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 10 September 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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 carried out an unannounced inspection of this service on 25 November 2020 and 05 December 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, to improve safeguarding people from the risk of harm, to improve staffing levels and improve how the service was led.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. 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.

Follow up

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

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-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 have identified breaches in relation to infection prevention and control; assessing care plans and risks; medicine administration; safeguarding people from abuse and harm; staffing and governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 have identified breaches in relation to infection control practices (the use of PPE); safe care and treatment (medicine administration, following care plans, lack of equipment); staffing and governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

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 and their wishes and preferences. People and their relatives were involved in the assessment process although they felt their views were not always listened to.

People were supported to take part in activities and encouraged to participate in events within the service. There was a complaints procedure in place to enable people to raise complaints about the service.

People and relatives had been asked for their feedback of the service and had attended meetings with the provider.

This is the first time the service has been rated Requires Improvement.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.