The Amwell

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 50 (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 always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Whilst the provider had informed us they had reviewed people’s care plans, we identified that some people still did not have care and support plans specific to them, including accurate information and pertinent details. There had been a high turnover of staff at the service and a recent recruitment drive to employ permanent members of staff and reduce agency usage. This meant newer staff were reliant on people’s care records being accurate and up to date with people’s needs, preferences or personal circumstances to be able to respond to them effectively.

One relative advised, “The keyworkers, in theory, are your point of contact, but they are not always on duty. Previously they knew her better, so feedback now is more difficult. They don’t know [loved one] as well.”

Some work had been done to improve people’s life histories and interests.

During observations at The Amwell, we did witness some person centred interactions between staff and people, though other elements of our findings did not support this as detailed throughout this report.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

A relative told us, “The attention of the staff means [loved one] is OK.” However, we found that communication and involvement with people’s relatives was not always well documented. One relative told us, “[Staff] are not communicating as well as they used to when [turnaround manager] was there.”

There was limited information recorded to demonstrate how the provider worked with others to ensure joined up care for people.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People and their relatives did not always receive information which was important to them, in formats they could understand. A large number of people living at the service had a diagnosis of dementia, however, dementia friendly signage was not used to maximum advantage to provide clear guidance for people to places such as the toilet. This reduced their ability to be able to independently orientate. A relative advised they often found their loved one had hearing aids with flat batteries, which impacted their ability to communicate.

Relatives sometimes found it difficult to obtain updates on their loved one’s care. One relative told us, “I didn’t know who the keyworker was, it’s no real benefit. They don’t come to me and tell me stuff, so what is the point?”

The provider did explain they could provide information to people in large print, or staff could read important notices to people if they preferred.

People, relatives and staff all told us they knew how to share feedback and raise concerns. However, it was not clear where action had been taken to make improvements in response to feedback received. For example, we raised concerns about staffing levels at our last inspection, relatives raised concerns about staffing levels at a residents meeting, and staff shared the same concerns at a staff meeting. This inspection found issues with staffing levels being able to meet people’s need remained.

The provider had a complaints file to log and record complaints, and whilst some had been responded to, we saw 1 serious complaint which had not been responded to. We also received feedback from the complainant during the inspection process, to advise they had been waiting for an unacceptable amount of time [i.e. out of the set time of the provider’s policy] to receive a response or an apology, for the incident which had occurred. Some complaints had been responded to in line with the provider’s policy.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Relatives’ experiences differed regarding their family members equal access to services. Some believed their loved ones were referred on promptly when needed, whilst others provided examples of where this had not been completed in a timely manner.

Care documentation did not demonstrate how people who were not able to share their views or actively participate in their care decisions were supported to receive care in a way they required. For example, for people living with dementia it was not clear how the provider ensured people’s sensory and emotional needs were considered and met.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

People’s experiences of care and support differed, and some of this was due to differing needs. Where people were able to access the activities that took place in the service their experiences appeared positive. However, for people who were not able or who did not have the opportunity to participate in these activities, their days consisted of task-based care, with a lack of meaningful engagement.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People did not consistently have their aspirations, ambitions or goals recorded.

The management team recorded functional and task centred aspects of people’s future wishes including funeral arrangements and a desire to remain at The Amwell. However, the personal aspects and preferences were not recorded in people’s future wishes.

Some people had Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. This is a document that outlines a person's preferences for emergency care, particularly in situations where they may be unable to communicate their wishes. However, there was limited information recorded regarding their choices and preferences in the event of their death. For people who were unable to share their wishes end of life care plans stated for staff to discuss plans with next of kin, however, there was limited evidence to demonstrate these conversations had taken place.