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 changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider was previously in breach of the legal regulation in relation to
governance. Not enough improvements were found at this assessment and the provider remained in breach of this regulation.

This service scored 57 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The management team and staff had a shared vision and culture based on listening, learning and trust. The management team were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally. One staff member told us, “None of the regional managers are shy to help out, they will get their hands dirty, they are very present and we appreciate that.” Another said, “Staff morale is much improved. The quality of staff has improved. The culture is being tackled and the introduction of new staff and management including a deputy manager.”

The management team were knowledgeable about their regulatory responsibilities and about the priorities for the development of the service.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation.

Since the last assessment the provider had ensured inclusive leaders were at all levels who understood the context in which they delivered care, treatment and support. Leaders were accessible and engaged with people and staff and demonstrated a respectful and caring approach. They engaged positively with inspectors, listened to feedback and responded respectfully to concerns raised during the inspection. However, communication between staff and management was inconsistent as detailed throughout the report and there was a need for clearer roles and responsibilities to be established for senior care staff and team leaders to ensure uniformity and promote effective communication across the staff team and management. While the provider had recently recruited a deputy manager a few weeks before our assessment to oversee staff roles more time was required to embed the management changes and stabilise leadership at the service.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People, their relatives and staff were all free to speak up if they had any worries or concerns. Staff were able to raise concerns directly to the provider if they needed to and knew who to contact if they needed to whistleblow to an external organisation. One staff told us, “[Managers] are great and I wouldn’t hesitate to raise concerns.”

Relatives and people were positive about the management of the service. One person told us they would feel comfortable raising any concerns but had not had to.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

There was a policy in place to protect staff from harassment and bullying and a focus on protected characteristics under the Equality Act. The registered manager had developed an inclusive workforce and recognised the value of diversity amongst the team.

Most staff felt respected, supported, and valued. They said the provider promoted equality and diversity in daily work and provided opportunities for development. They could raise any concerns without fear.

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

Although there had been improvements in the systems in place to monitor the quality and safety of the service, there were still further improvements needed to ensure the systems were fully effective. For example, the provider’s own governance systems failed to identify and act on shortfalls in medicine management we found during this assessment and previous assessments. This is the third consecutive assessment where the provider has failed to meet the regulations. There have been repeated breaches in relation to safe care and treatment and good governance across all 3 assessments.

There were a wide range of audits and checks carried out by the provider and registered manager. Audits included, incidents and accidents, infection control, and health and safety. These audits identified areas of improvement and had action plans. In addition, a service action plan was in place which incorporated actions identified through these systems. However, as detailed throughout the report the provider did not always identify the concerns found during this assessment, and previous assessments, where issues remained with internal communication, and risk mitigation.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Feedback from partners was mixed. While partners reported improvements in the delivery of care, they told us further action was needed to strengthen communication and ensure positive changes were consistently maintained over time. One professional told us, “They are still on a journey…...There needs to be a strategic and effective management plan, to mitigate against risk.”

The management team recognised the need for continued improvement in the development of community partnerships.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. However, there were still areas where improvement continued to be needed and embedded.

The provider was engaging in a quality improvement process with the local authority and other partners. Although this had led to improvements, support was still required to ensure the service provided consistently safe and effective care and with sustained governance procedures.

Feedback from people and relatives had improved significantly since the last assessment and they told us they could see improvements had been made at the service. One relative told us, “I do feel they’ve improved, and I do feel they care.” Another commented, “I’m very impressed with the changes that [managers] made.”