The Amwell

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to operating effective systems to assess, monitor and improve the quality and safety of services provided; operating effective systems to assess, monitor and mitigate risks relating to the health, safety and welfare of service users and others who may be at risk; and keeping accurate and contemporaneous records in relation to people who used the service and staff members.

This service scored 32 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

People living at the service were at increased risk of receiving harmful care due to the existence of a closed culture. During our assessment, multiple closed culture indicators were observed, such as a large amount of agency staff use, lack of governance within the service by the provider, people and relatives feeling uncomfortable to speak up, care plans not being reflective of people’s needs, and people being highly dependent on staff for their basic needs to be met.

Staff agreed the culture of the service was poor and told us this had stemmed from the previous manager who had failed to get to know the people living at the service, failed to implement appropriate care plans, and failed to provide support, guidance, and oversight for the staff. One staff member said, “[Previous manager] never came up onto the floor,” and explained the previous manager did not know which person lived in which room within the service.

We heard staff voice the need for strong and consistent leaders to improve the direction and culture of the service.

A new home management team, made up of experienced personnel, had been implemented in November 2024 with the aim of improving all aspects of the service.

Whilst there was a manager registered with the CQC at the service, they had left their role 2years ago. Since the registered manager left, the service had experienced unstable leadership with a number of different managers. A staff member stated, “There has never been a consistentmanager that has been strong enough to keep the home running well.”

Staff told us the most recent interim manager spent a lot of their working hours walking aroundthe local area, rather than being at work supporting the staff and ensuring the smooth running of the service.

We heard leaders across the service were out of touch with problems occurring inside the carehome, including issues around staffing. A lack of consistent staffing was identified during this assessment. Staff explained higher staffing levels were needed, and that it was difficult to takeannual leave. One member of staff told us, “A regional manager from somewhere sat in theresidents meeting recently and said the home is overstaffed.”

Staff told us clearly what they needed to be able to improve the quality of care within the carehome, including urgently needing structure to be put back into the service, and into care delivery on each floor of the home, and strong leaders who knew the people living at the service well.

Staff also raised the importance of the manager being present, and visible on the floors of thecare home. Staff told us they needed further training and guidance to ensure they could care forpeople safely, and support to improve their confidence. One staff member said, “The trainingneeds improving, some staff need a bit more assistance and guidance. Staff need more confidence to know what to report and how to report it.” When asked if this was from the managers or from additional training, they replied, “Both. The whole situation is worrying.”

People did not feel they could speak up and that their voice would be heard.

Staff told us they did not feel comfortable raising concerns about the service to leaders.

Leaders were described by staff as unapproachable, and that leaders ‘shut down’ when being spoken to by staff.

One staff member told us about a safeguarding incident which had occurred, and no action had been taken. The staff member raised this to a senior leader within the provider, who “swept it under the carpet.”

We heard from another staff member who had observed an incident of abuse taking place. The staff member told us, “I didn't get the support I needed from management to let me report it.”

A number of staff had whistle blown to either ourselves or the Local Authority as they did not feel they could raise their concerns internally.

Staff did feel more confident the new turnaround manager would listen to them if they shared concerns. Relatives also reported having more confidence in the turnaround manager if they wished to report concerns. One said, “I do feel confident that if I had even a small concern that [turnaround manager] would take it seriously.”

The provider did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

We heard from staff and relatives there was disconnect between staff roles within the service.

One relative told us nursing staff had been refusing to help the carers. The relative explainedthis was building animosity between care staff and nursing staff. They also told us particular members of the staff team were always busier than others, “The seniors are running around likeblue-[bottom] flies…The staff need to be nurtured and loved.”

Staff voiced concerns over the effectiveness of some team members, one stated, “The nurses are just here to medicate.”

Staff told us agency workers did less work than permanent staff, which did not support harmonious workplace for staff.

The provider did not have clear responsibilities, roles, systems of accountability and good governance.

Whilst the provider’s systems and processes for making checks on the quality of service were robust, previous managers either failed to use these correctly, or failed to act where concerns had been identified. This included managers at regional level. This meant issues were either undetected or left without remedy for extended periods of time.

We identified a number of incidents which had occurred over recent months, where a statutory notification to ourselves should have been submitted. The lack of governance and oversight within the service had meant this had not been identified prior to our assessment.

Record keeping across the service was poor, and there were a significant number of missing records, documents that could not be found, or incomplete records. We also observed confidential information about people living at the service to be displayed in an area which visitors could see.

Staff told us they were unclear on their roles and responsibilities within the care home. One staff member told us, “We do what the manager says but they all say to do different things.” Another staff member said, “We don’t know whether we are coming or going.”

We held a provider meeting with the Nominated Individual, a number of managers with the senior leadership team and the newly appointed turnaround manager. The provider acknowledged the failings across the service and provided assurances they would immediately take steps to begin to put right the issues identified through our assessment process. The Nominated Individual advised several new personnel had been appointed, including a clinical lead and a new registered manager. The provider assured us they would not remove the current turnaround manager until the new registered manager had commenced their post and been satisfactorily inducted.

The provider did not always understand their duty to collaborate and work in partnership, soservices worked seamlessly for people. They did not always share information and learning with

partners or collaborate for improvement.

The service had not always worked well with their local GP surgery or pharmacy. This had, on occasion, impacted people getting the right medical help at the right time, and contributed to

some medication errors. However, since the appointment of the turnaround manager, we heardimprovements had been made in this area and that the turnaround manager was working hard

to build positive relationships with the local GP surgery and pharmacy.

The provider had failed to ensure continuous learning and improvement had been made across the service; however, they had recently acknowledged the failings of the service and employed a turnaround manager to drive improvements,

The turnaround manager had already started compiling a list of concerns across the home prior to our assessment and advised us this would be developed into an action plan to drive improvements.

We found the turnaround manager to be open and honest about concerns across the service, and effective at communicating the changes they had already made in the 1 week they had been in post. They were realistic about areas which could be improved quickly, and other areas which would take longer to ensure the tasks were completed accurately and robustly. They also identified the need to make improvements sustainable, to prevent the service declining again once their focus had moved to another area of the care being delivered.

Staff and relatives were complimentary about the immediately positive impact the turnaround manager had on the delivery of care and provided many optimistic comments. One relative said, “I have noticed that over the last week things have improved for example there is a smell of fresh paint, there seem to be loads of managers milling around and the activity level seemed to have gone up. I saw my relative with a crossword and some jigsaws and that's the first time I've ever seen that.”

Other comments included, “We are impressed with [turnaround manager] and our expectation is that if he stays things will improve,” and “We have found him to be excellent and so hands on.”

A staff member told us, “I wish [turnaround manager] was going to be permanent here, he is really doing well. He is someone who is not afraid to tell staff if they are doing wrong, and we need such a leader in this home.”

Staff also described an improvement in staff morale since the new turnaround manager has commenced their post.

Staff told us they wanted to be involved with the plan for recovery and improvement for this service.