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 inadequate. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The provider was previously in breach of the legal regulations in relation to eating and drinking, person centred care and mental capacity. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider had made improvements to how care plans were monitored, reviewed and audited to ensure they were person-centred and met people’s needs. Developments and improvements to care planning and review processes was ongoing to ensure they were sustained and embedded.

People and relatives told us care plans were developed in partnership with them. One person said, “They sat down initially and discussed the care I needed.” Another commented, “There is a care plan. They update it with me.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider used recognised tools to assess and identify risks to providing people’s care and support. This included the International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI is a standard for describing food textures and drink thicknesses for people with swallowing difficulties. Using the IDDSI, care plans clearly identified how some people needed their food prepared or to what consistency they needed their drinks thickened to reduce their risks of choking. Supplementary food and fluids charts and daily records completed by staff, accurately recorded people’s food and fluid intake.

Kitchen staff told us they were informed about people’s nutritional needs and updated if those needs changed. This included in relation to any modified diets, allergies or weight loss.

People and their relatives were positive about the food in the home and how their nutritional and hydration needs were met. Comments included: “On the whole the food is good; I get 2 choices when I sit down. They show you 2 dishes” and “I like the food very much. They bring drinks for me as well.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Communication processes between staff and management were not always effective. As a result, there were occasions where information was not escalated appropriately, leading to missed opportunities to share concerns with the GP. Feedback from external partners supported this finding and highlighted inconsistencies with communication. One professional told us, “The communication between [registered manager] and senior carers is where there is a breakdown. If [registered manager] doesn’t know things during our meeting [they] have to check with the seniors and get back to us.”

We raised this concern with the provider during the assessment. The provider acknowledged the issue and told us they were taking action to review and improve systems for sharing information with external healthcare professionals.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Care records contained detailed information about people’s health conditions and how these might affect people. There were regular visits from health care professionals involved in people’s care, and communication between them and the staff and management was improving.

Most relatives felt their family members’ health needs were met. One relative said, “‘The GP saw [person] last Tuesday about [their health need]. The optician has been in too.” However, 1 relative told us that there were occasions when medication changes were delayed while staff contacted the GP and obtained an updated prescription.

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

Most people received regular care and support from staff, and their health needs were monitored. However, we identified where people had been regularly refusing their medicines this had not always been escalated to the GP to review. Additionally, we observed 1 person on inspection complaining of pain to their limb, but this had also not been referred to the GP for review. The provider was informed of these findings and took action during the assessment process to address these.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The Mental Capacity Act 2005 (MCA) establishes the legal framework for decision-making on behalf of individuals who may lack the capacity to make specific decisions themselves. The MCA requires that, wherever possible, individuals are supported to make their own decisions. When a person is assessed as lacking capacity for a particular decision, any decision made on their behalf must be in their best interests and represent the least restrictive option available. Where individuals were assessed as lacking capacity, mental capacity assessments had been completed.

People and their relatives told us staff always asked for consent when they were providing support.One person said, “Staff usually knock first and come in.”

Staff had completed training on the MCA and demonstrated a clear understanding of its principles. Where people required assistance with decision-making, staff were able to tell us how they applied best-interest decision processes and ensured that any actions taken were the least restrictive option. One staff member told us, “We always assume someone has the capacity. We can intervene if we feel they are at risk.”