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 inadequate. At this assessment the rating has remained 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 good governance at the service.

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. They did not understand the challenges and the needs of people and their communities.

The provider had not shared their vision and values clearly with staff. Staff were able to clearly describe their own values and visions for the service, but there was no shared collective approach.

Leaders failed to monitor the service in line with their values.

Staff had worked hard to engage more collaboratively with people and colleagues since the last inspection, however the service still lacked shared direction and guidance from the provider. This has meant people have not received a good, safe service for consecutive years and the provider has not been able to demonstrate the leadership and direction required to drive improvements, meet people’s needs and sustain a good standard of care.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Not enough improvements had been made since the last inspection to satisfy the previous breaches of legal regulation. The provider was still out of touch with the issues faced by staff working at the service, including continuing issues around insufficient staffing levels to meet people’s actual needs, rather than their planned needs. Staff raised again at this inspection the need for increased staffing levels.

Leaders from the provider had regularly completed visits to the service, to check on progress against the actions required from the last inspection. One leader had identified repeated issues with the outside bin store not being locked, and food in kitchenette fridges not being labelled. At this inspection, we found the outside bin store to still be unlocked, and kitchenette fridges to still contain unlabelled and opened food and drink. Another visit had only identified the garden requiring some tidying, despite all of the continued issues identified at this inspection being present. This meant the actions taken by leaders were ineffective at driving sustained change.

Where things had gone wrong, we heard people did not always receive a timely and sincere apology. One relative advised their loved one had been involved in an incident which caused them a significant injury some months ago, however, they were still waiting for an apology from the service.

This inspection found some improvements in staff feeling they could speak up and be listened to, however feedback was still mixed. Some staff told us issues they had raised were not acted upon, other staff were more positive that they would be listened to, with 1 staff member stating, “I feel confident raising any safeguarding concerns, and I trust that the management team would respond appropriately to any serious issue.”

Supervisions had not been completed regularly with staff, which limited the amount of ways staff could raise concerns.

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

Staff feedback was mixed, with some staff feeling undervalued and not always included, with others complimenting the provider’s approach to inclusion.

The recruitment process demonstrated a fair and equitable approach, resulting in a workforce that reflected diversity.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Whilst the provider’s systems and processes for checking on the quality of service were robust, managers and leaders at provider level either failed to use these correctly or failed to act where concerns had been identified. This meant issues were either undetected or left without remedy for extended periods of time. This was raised at our last inspection, and the provider had failed to make enough improvements within this area.

Concerns still remained about record keeping across the service, with missing records, incomplete records or inaccurate information contained within the documents. This included documentation to be compliant with Mental Capacity Act 2005.

The provider had not communicated job roles and responsibilities clearly to all staff members. Some staff had been employed to complete a specific role, but at the time of the inspection, were completing a different role, with no clear job description.

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

Records evidenced that on some occasions, people could not have their medicine as prescribed due to the care home running out of the particular medicine. This was identified as a concern at our last inspection, and the provider advised us they were working to improve their relationship with the GP surgery and local pharmacy to prevent this occurring in future, however medicine shortages were identified at this inspection.

District Nurses visited regularly to change dressings for people with active pressure sores. We identified conflicting information on the provider’s records about people’s pressure sores and the management of these, which meant they did not have accurate information to share with the local nurses.

Some people living at the service had been identified as being at risk of dehydration or malnutrition. We could not find clear evidence that a GP had been involved for 1 person with significant weight loss, and other documents regarding people’s food and fluid intake were not completed fully which meant accurate information could not be shared with visiting health professionals.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Since this service was registered in 2017, this is the fifth inspection to find failings and breaches of legal regulation. This is also the second consecutive inspection where significant concerns have been identified in respect of the safety of people’s care and the management of the service. This meant the provider’s overall governance systems were not effective in learning from experiences or driving good care. This lack of effective management put people at the risk of avoidable harm as the provider could not be assured people’s needs were effectively assessed or their care planned to reflect best practice.