The Amwell

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 59 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The management team had undertaken analysis to identify the root causes of incidents, and appropriate actions had been implemented to reduce the likelihood of recurrence. For example, at the previous assessment, post-falls observations were not consistently completed in accordance with the provider’s protocol. At this assessment, improvements were evident; through reflective practice and staff supervision, post-falls observations were being carried out more consistently and in line with the provider’s procedures. Daily handovers between staff across different shifts kept everyone updated about any changes or concerns they needed to be aware of.

There was evidence of openness and transparency, in line with the duty of candour requirements. The registered manager was clear about their responsibilities for reporting to the CQC and the regulatory requirements of their role.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always work well with people to understand and manage risks.

People’s care plans included risk assessments to guide staff in supporting people safely, covering areas such as moving and handling, eating and drinking, and specific health conditions. In most cases, records reflected people’s needs appropriately. However, we identified an isolated inconsistency within 1 care plan, where guidance regarding the frequency of repositioning for a person at high risk of developing pressure injuries was not clearly aligned. This was addressed to ensure information was accurate and provided clear direction for staff to support the person safely.

At the time of the assessment, the management team had identified the need to improve the quality and accuracy of care planning and had commenced a service-wide review. This included auditing existing care plans, updating risk assessments, and revising guidance to ensure consistency across records. Systems were being strengthened to support regular review and oversight; however, these processes were not yet fully embedded, and improvements were still in progress.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

While some positive steps had been taken from the previous inspection, we still identified inconsistent practices across some areas of medicines optimisation.

Staff were observed to be caring during a medicine round. Medicines support (including administration) was recorded accurately and contemporaneously. An accurate record was made when medicines were not administered, for example: person asleep, medicine out of stock, refused. Staff had dedicated time to manage medicine processes, such as ordering and receiving medicines.

Staff received medicines training and their competency was assessed annually. People received medicines safely, as prescribed, and at the right time. We checked the quantities and stock levels of medicines and found the stock balances to be correct. This meant we could be assured that people had received their medicines as prescribed.

Medicines with a limited shelf life, once opened, had a date of opening and an appropriate expiry date, ensuring medicines were not being used past the expiry date.

Medicines were stored safely. Controlled drugs (CDs) were stored securely in line with legislation and policy. CD stock checks were carried out in accordance with the provider’s policy. However, the controlled drug register for 2 entries had been crossed out rather than amended in line with national requirements. The provider identified the staff involved and was in the process of ensuring they received appropriate training to correct this practice.

On inspection, we found that in one clinic room, the fridge temperature had been exceeding the maximum temperature (8 degrees) for an extended period and had not been addressed or escalated to management. On the day of the inspection, the fridge was empty, which meant the risk was low.

Best interests’ decision meetings had taken place for people who had had their medicines administered covertly (disguised in food or drink). Pharmaceutical advice had been requested and was in place to ensure that medicines were administered safely.

A new electronic medication administration record (eMAR) system was implemented over 1 month ago, and people’s preferences for how to take their medicines had not yet been transferred from paper records. However, the paper sheets with this information had not been updated since the last inspection for people, for example, a person who was now given covert medicines had not had the cover sheet updated. On inspection, we saw that the front cover sheet for a person stated no allergies; however, the care plan listed numerous allergies, indicating inconsistent information. There was a risk that staff might not have access to accurate, up-to-date information needed to provide safe care to this person. The provider informed us that addressing allergy documentation and individual preferences was the next planned area for improvement, following the first month of implementation of the eMAR system.

Care plans lacked person-centred detail and did not always reflect current medicines; for example, a person was on a reducing dose to stop a medicine, but the care plan had not been updated to reflect this. Care plans also lacked the reasons why medicines were prescribed. A person on an epilepsy medicine had no mention of epilepsy in the care plan. One person on a blood-thinner (anticoagulant) was missing information about this in the care plan.

When required (PRN), medicine protocols were in place for all people to help staff administer these medicines correctly and contained information on when to give them.