Immediate improvement is required to keep patients safe following an inspection at a Mental Health Unit in Llandough Hospital
Healthcare Inspectorate Wales (HIW) has issued a report (20 April 2023) following an inspection of the Pine and Ash Wards within the Hafan Y Coed Unit, which specialises in mental health care at University Hospital Llandough.
Inspectors issued an immediate assurance letter to Cardiff and the Vale University Health Board, following evidence staff had participated in incidents of restraint, without the required levels of training. This meant that we were not assured that staff and patients are being fully protected and safeguarded against injury. The inspection did highlight staff within the wards were committed to providing safe and effective patient care.
HIW completed an unannounced inspection at the hospital on three consecutive days in January 2023. During this period a number of assessment areas were inspected within the Pine and Ash Wards, which provide adult mental health services for in-patient detoxification and neuropsychiatry.
Patients when asked through a questionnaire said the care provided by the hospital was either ‘very good’ or ‘good’. Inspectors witnessed staff interacting and engaging respectfully with patients and their visitors. The staff our inspectors spoke to were passionate about their roles and enthusiastic about how they supported and cared for their patients. Both wards provided a calm and therapeutic environment for patients, which was in keeping with their needs. The service should ensure patients are following smoking legislation within the hospital, and patient bathrooms must have appropriate privacy doors fitted. Inspectors recommended a process should be put in place for patient feedback and specific language and communication needs should be reviewed to ensure their services are accessible.
When examining staff training records, rotas, and incident forms, inspectors noted that overall staff compliance with mandated ‘Managing Aggression’ training was low, with just over half of the staff on the Ash Ward completing the training. An immediate assurance letter was issued as documentation evidenced staff had taken part in incidents of restraint without the required levels of training. Inspectors recommended that the system used for recording staff training should be reviewed with a view to records kept in one place for easier monitoring. The health board should also ensure that personal alarms are working and provided to all staff.
Patient care and treatment plans were well organised and easy to navigate, but inspectors found that the quality of the plans, did vary across the wards. Patients were involved in their care planning, but measures should be undertaken to ensure that care plans are completed correctly, contain sufficiently detailed information, and are individualised to patients. Medication administration records were also not consistently signed and dated, causing potential confusion for staff, and ultimately posing a risk to patients.
Inspectors witnessed strong team working on both wards. Staff members who responded to our questionnaire recommended the hospital as a good place to work and agreed that they are happy with the standard of care provided. The leadership team was approachable and appeared supportive to staff with a good understanding of patient needs. Some staff did express the view that working practices could be improved with better visibility and involvement from the senior management team. Inspectors saw evidence of good collaborative working across the health board to support improvement and disseminate quick learning from incidents.
Chief Executive of HIW, Alun Jones said:
Our inspection identified many areas for improvement, with some requiring immediate assurance to reduce risk to patients, visitors, and staff. Staff within the wards are clearly passionate about their roles and patients overall are receiving quality care. It is worrying, however, to see low levels of mandatory critical training within these wards, the health board must ensure robust plans are put in place to train staff to the required level. Cardiff and the Vale University Health Board has produced a plan which sets out improvement actions as a result of this inspection work. HIW will monitor the health boards’ progress against this plan.