About the service

The Amwell is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. that offers care and support to 88 older people, some of whom are living with dementia. At the time of the inspection 52 people were living at The Amwell.

People’s experience of using this service

People were happy living at The Amwell. They told us they felt safe and secure. They liked the staff who looked after them. The premises were kept safe and were well maintained.

Staff knew each person well. They knew about people’s likes and dislikes and their preferences about how they wanted to be looked after.

People’s care plans included assessments of risks associated with their care. Staff followed the risk assessments to ensure that people received safe care. Staff knew how to report any concerns about people’s safety and well-being. to and assessments of potential risk ensured that people were as safe as possible.

There were enough staff so that they could meet people’s needs in a timely way. Staff went through a thorough recruitment process so that the provider knew they only employed suitable staff. Staff undertook training that supported them to have the knowledge and skills to do their job well and effectively meet people’s needs.

Staff gave people their prescribed medicines safely. Staff followed good practice guidelines to help prevent the spread of infection. The premises were clean and fresh.

People enjoyed their meals. They had a choice of meals and when to and where to eat them. The kitchen staff cooked a variety of nutritious meals, based on people’s choices and including special diets for those who needed them.

People had access to health services when they needed them. Healthcare professionals supported staff to help people maintain or improve their health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People made choices in all aspects of their lives. Staff respected people’s choices and preferences and people’s views were listened to and acted upon.

Staff respected people’s privacy and dignity and encouraged people to be as independent as possible.

People had use of facilities at The Amwell such as a gymnasium, a cinema and music room. Staff supported people to participate in activities and to follow their hobbies and interests.

The registered manager monitored the quality of care and support people experienced and acted on their feedback.

Lessons were learnt when mistakes were made. Actions were taken to reduce the risk of people experiencing harm.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service as requires improvement (report published on 24 April 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The Amwell is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service offered support to older people and people who were living with dementia or physical disabilities. At the time of our inspection there were 47 people using the service. The Amwell is a purpose built and set over four floors. There was a communal lounge and dining room on each floor. The Amwell had a gym, a cinema, a bistro and a hairdressing salon available for people to use.

This was the first inspection of The Amwell since its registration with the CQC.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Quality assurance systems were in place to monitor and review the quality of the service which was provided. These had not been used effectively to drive improvement in the service and had not identified the concerns we found.

Risks to people were assessed and monitored regularly. However, the information included in the assessment was not always updated if a person’s needs changed. There was no clear guidance for staff about how to support a person if they became aggressive.

Checks on the environment had not all been completed at the required frequency, however were being updated during our inspection.

People told us they had to wait for support. Staffing levels had been assessed and the registered manager told us they would continue to monitor these. Safe recruitment processes were in place.

Systems were in place to ensure the premises were kept free from infection and hygienic. These were not always followed by staff. There were processes being developed to make sure action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff had not received training and support to carry out their roles. Training was available but staff had not been supported to complete this. Staff had started their employment before they had completed appropriate training.

People were supported to maintain their health and well-being, although the care given to people to show this was not consistently recorded. Where a person was at risk of not eating enough the records of what they had eaten were not regularly completed which appeared to show people had sometimes only had one meal and limited drinks. Staff confirmed people were eating and drinking and this had not been recorded.

People’s needs were assessed and their care was sometimes provided in line with up to date guidance and best practice. The premises and equipment were not fully adapted to meet people’s needs

People usually felt safe when they were receiving care from staff. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

People were supported to take their medicines. There were processes in place which staff followed to make sure people received their medicines safely.

Staff demonstrated a limited understanding of the Mental Capacity Act 2005. They gained people's consent before providing personal care.

People’s private information was not always kept securely to maintain their confidentiality.

People felt they did not receive staff support at times they needed this. They felt they did not always get to know staff due to changes in the staff team.

People were treated with dignity and respect and staff ensured their privacy was maintained. People were sometimes encouraged to make decisions about how their care was provided.

Care plans were not focused on the person