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 requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes. The service was in breach of legal regulation in relation to person-centred care and consent to care and treatment.

The service was in breach of legal regulation in relation to eating and drinking, person centred care and mental capacity at the service.

This service scored 38 (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 make sure 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 number of contradictions across a range of people’s care records. This meant staff did not have an accurate record of people’s needs and therefore, how to support them effectively.

Important information to help guide staff was missing from some care plans. For example, a person with a dementia diagnosis who experienced ‘sundowning’ (a set of behavioural changes that occur in the late afternoon or evening, often around dusk) could become involved in altercations with other people living at the service due to their distress causing other people to become distressed. The care plan failed to provide guidance for staff on how to give reassurance to the person, or tried and trusted distraction and calming techniques the person responded well to.

Whilst care plans and risk assessments were regularly reviewed, the reviews were completed by some senior staff who had not completed the relevant training for care planning. This meant the reviews were not robust and we identified a number of issues where care plans and risk assessments had been confirmed as being reviewed, but had not been updated, leading to them containing inaccurate information about the person’s current care needs.

Relatives told us they were sometimes included in the creation of some care plans.

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.

Our last inspection identified concerns in relation to people not being offered, or receiving enough to drink throughout the day. At this inspection, the same concerns were identified.

Records showed some people were only being offered minimal amounts to drink throughout the day, meaning these people were more likely to experience health complications associated with dehydration.

A data analysis of the provider’s care planning system showed a substantial amount of interventions to provide drinks to people had not been confirmed as occurring.

Additionally, this inspection found concerns where people required a fortified diet to prevent weight loss. The provider completed nationally recognised tools such as MUST to help them assess whether people were at risk of malnutrition. A person had been assessed as being at risk of malnutrition, and required their drinks to be fortified with additional calories to prevent further weight loss. Records did not evidence any drinks they had been offered over a 90 day period had been fortified, and as a result, their most recent weight showed they have lost 11% of their body weight since our last inspection.

One relative told us they felt their loved one did not receive an afternoon drink and snack unless they were visiting at the time. Another relative stated that whilst their loved one did have a water jug accessible in the bedroom, it was too heavy for them to lift meaning the person could not access the water.

Feedback about the quality and choice of food was mixed. One relative said, “In the brochure it says, ‘high class menu’. One day they had bean soup, cauliflower cheese and semolina. The menu is not great. It has gone downhill since Christmas. There is always a choice and often one is soup. They seem to serve a lot of bean soup, which I wouldn’t fancy. There is often a cooked breakfast.” A person who lived at the service said they had found the food to be delicious and plenty of options to choose from, and some relatives complimented the quality of food.

Feedback about how teams work together identified some concerns.

A staff member told us when leaders from the provider come to the service, they do not engage well with the staff team, “sometimes not even saying good morning.” Additionally, staff told us there was very little praise and recognition for staff members who were trying to do their best. One staff member said, “We actually have [employed] some amazing care staff this pastyear. But I fear without this praise we'll lose them.”

A relative raised a concern over communication between the service and external health professionals, resulting in a person not receiving their prescribed medicines. They said, “[There was a] communication problem with the mental health team and The Amwell. They thought [person’s] medication had been stopped – it hadn’t. I had to chase around to get it sorted out. Sometimes they only have a few days of medication left, I think they should keep more in stock.”

The provider joined a weekly a multi-disciplinary team meeting with external health professionals to discuss concerns and share updates on people’s health and wellbeing and this was reported to be beneficial.

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 support people to live healthier lives, or where possible, reduce their future needs for care and support.

A person living at the service had a diagnosis of dementia and often became anxious in the evening. The provider has not recorded any guidance for staff in the person’s records to enable staff to help the person keep calm, or proactive ways to get them to accept support.

Another person could become agitated, and this meant the person could display self-injurious behaviour such as hitting their legs and picking their skin until they drew blood. A robust risk assessment with guidance for staff to support the person’s wellbeing was not in place at the time of our inspection.

One relative said their loved one enjoyed using the onsite gymnasium equipment, and was encouraged and supported to complete gentle exercises.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Where people had experienced a fall, post fall monitoring checks were not completed as per the provider’s process. The process was that people should receive a substantial amount of checks over a 24 hour period following a fall, to ensure there were no significant injuries or complications which required medical attention. Records showed these checks had rarely been completed in full. This meant there were a significant number of gaps in observations after people had fallen, and staff could not quickly identify if a person needed medical attention or had come to harm as a result of their fall.

The provider’s clinical risk register was not up to date at the time of inspection. Some information conflicted care plans and our conversations with staff, and other information was missing. This meant the provider did not have access to accurate information to help them monitor clinical risks.

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 had been agreed upon in their best interests. When best interest decisions were completed, they did always include input from relatives and others who knew the person very well.

Some people’s mental capacity assessments were found to contain conflicting information, including somebody else’s name. We also identified instances where mental capacity assessments were not decision specific.

An audit completed by the provider in February 2024, identified not all mental capacity assessments and best interest decisions were in place where appropriate. We raised the concerns we found at our last inspection, however issues were identified again at this inspection. This meant the provider had failed to operate within the Mental Capacity Act 2005 and associated codes of practice for an extended period of time.