The Amwell

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to providing evidence people received sufficient hydration to sustain good health; ensuring people had mental capacity assessments and best interest decisions where appropriate, and delivering person-centred care at the service. 

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not ensure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

We identified a significant number of contradictions across a wide range of people’s care records. This meant staff did not have an accurate picture of people’s needs and therefore, how to support them effectively. For example, a care plan for a female residing at the service, contained information relating to a health condition only a male could experience. Staff had reviewed people’s care records regularly but failed to notice the large number of inaccuracies.

A relative told us they had repeatedly raised concerns about their female family member being washed by male staff, which was against the person’s wishes.

It was not clear when relatives had been invited to collaborate in the care planning process, and only 1 relative could recall being involved in a care plan review.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

It was not clear if people were offered, or received, sufficient hydration to meet their needs and to sustain good health. People did not have personalised fluid intake targets, and a blanket target had been applied to a number of people living at the service. Records showed that people were not being offered an adequate amount of fluid throughout the day. This meant people were more likely to experience health complications associated with dehydration.

Relative feedback supported the concerns identified by inspectors. One said, “I don't think they encourage her to drink as much as I’d like them to.” Another relative told us, “As a family when we go to see our [family member] we often end up making drinks for other residents and talking to them as there is often no [staff] in the room.”

Relatives felt that staff did not adequately monitor their loved one’s fluid consumption. One explained, “[Staff] occasionally keep a fluid chart but they may put down that they have drank [X amount] of tea but often it's just that they've given [them] the tea and not that [they’ve] actually drunk it.” Another told us, “I know [they’re] given drinks but I'm not sure how much [staff] monitor how much [they’ve] actually drunk.” A concern was also raised regarding people living at the service who could not verbally communicate when they were thirsty.

People were generally pleased with the food provided. The meals we observed looked appealing and smelled appetising. One person explained there was a wide variety of choices including a full English breakfast every morning, and they enjoyed eating the meals provided. One relative told us, “[Family member] is eating well and slowly putting on a bit of weight and looks increasingly healthy. [They] are never without some form of liquid in front of [them] and there are snacks including fruit provided.”

Some positive feedback had been received regarding staff members working well across services. One relative told us, “[Staff member] is very proactive in sorting things out for my [family member] such as haircuts and vaccines.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always supportpeople to live healthier lives, or where possible, reduce their future needs for care and support. We were advised people’s personal care was not always carried out frequently enough to promote good personal hygiene.

One relative told us they had raised concerns about their loved one smelling strongly and requested they were showered more frequently.Another relative said, “A couple of times my relative's hair has smelled as though it's not been washed for a long time and [their] head becomes itchy so I'm not sure how often they shower orbathe the residents, and I've had to ask [staff] to shower [them] and wash [their] hair.”

We found care records did not always demonstrate people had received timely, effective care. We also identified unclear information within people’s care plans with a lack of guidance for staff. For example, 1 person’s record identified the signs that their medicines may not be working correctly, however, there was no information on whether the person was able to identify this themselves, and telephone the GP, or whether staff were required to complete this.

The turnaround manager acknowledged that care plans had fallen below the expected standard, and advised all care records were going to be reviewed in depth as part of the improvement works at the service.

The provider did not always routinely monitor people’s care and treatment to continuouslyimprove it. They did not always ensure that outcomes were positive and consistent, or that they

met both clinical expectations and the expectations of people themselves.

A Local Authority contract monitoring visit in October 2024 had identified staff were completingfinger-prick tests twice daily before meals to record a person’s blood glucose levels. Written

authorisation for this delegated healthcare tasks had not been provided by a healthcareprofessional, and this had not been identified as a need for staff to complete. Completing this

task without a clinical reason could cause distress and pain to the person and was not in theirbest interests. Records of these blood glucose finger-prick tests were also not being consistently

recorded on the system so were not useful or reliable. The Local Authority raised this concernwith the management team, who took action to stop staff testing the person’s blood glucose

levels, and liaised with District Nurses.

The provider did not work in line with the Mental Capacity Act 2005.

People did not always have mental capacity assessments completed where required. Where a person’s care plan stated they lacked capacity, there was not always evidence of how this had been assessed appropriately to arrive at this conclusion.

Some people had appropriate capacity assessments in place, which determined they lacked capacity to make that specific decision. However, best interest decisions had not always been completed and this meant staff did not have sufficient guidance in place to enable them to support the person in a way that met their needs.

Where best interest decisions had been recorded, we found they did not always robustly describe the risks to the person. For example, 1 person had been assessed as lacking capacity around taking their prescribed medicines. The best interest decision stated staff would administer the person’s medicines, however, there was no explanation as to why this was important, and the risks posed to the person such as a decline in their health, if staff did not administer their medicine.

A number of the best interest decisions which had been completed, had no recorded input from relatives and others who knew the person very well.

An audit completed by the provider in February 2024, identified not all mental capacity assessments and best interest decisions were in place where appropriate. This meant the provider was aware not all necessary documentation had been completed for a significant period prior to our assessment.