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Immediate improvement is required at a specialist mental health unit within Ysbyty’r Tri Chwm

Healthcare Inspectorate Wales (HIW) has issued a report (10 November 2023) following an unannounced inspection of a specialist mental health unit in Ebbw Vale.

Cedar Parc Ward Ysbyty'r Tri Chwm Mental Health Services

During the inspection a number of governance, patient safety, privacy and dignity issues were identified, which required immediate action by the health board. It was also disappointing to note that some of the issues had not been resolved following a previous inspection in 2018.

The inspection of the Cedar Parc Ward at Ysbyty’r Tri Chwm took place over three consecutive days in August 2023. The hospital, run by Aneurin Bevan University Health Board provides mental health services for people over 65. Our inspection focused on the Cedar Park Ward, which has fourteen beds and provides specialist assessment and treatment to dementia patients.

Inspectors could not be assured that the health, safety and welfare of patients, staff and visitors was being actively promoted and protected. In addition, potential risks of harm were not being identified, monitored and where possible, reduced or prevented. Several issues required immediate action by the health board, for example, inspectors observed missing handrails in the ward corridors with exposed sharp edges which posed a risk of injury. Inspectors also found the call bells within patient bedrooms were located across the room from patient beds and others were positioned where they could not be reached by patients whilst lying down. We were provided with restraint data which indicated that within the past three months, four patient restraints had been conducted by staff who were non-compliant or had not completed the relevant training. Furthermore, the health board’s ‘Use of Restrictive Physical Intervention’ policy was out of date since 2019. We also identified a general lack of communication between senior staff and ward staff and were not assured that the hospital’s governance systems and arrangements supported continuous improvements and shared learning from serious incidents.

Overall staff were treating patients with respect, and when asked those who completed our questionnaire confirmed staff were polite, supportive, and helpful. Nursing staff were found to be knowledgeable regarding individual patient needs, and good professional relationships had been developed to support patient health and wellbeing. Inspectors observed staff using innovative ideas and techniques to engage with patients which was identified as good practice.

Inspectors found patient records evidenced detailed and appropriate physical assessments and monitoring. Care and Treatment Plans (CTPs) were individualised, person-centred and reflected the needs and risks of the patients in the hospital. However, several issues were identified that compromised the privacy and dignity of patients. Issues included the ward having insufficient washing facilities and no designated gender toilets. The covered vision panels within patient bedroom doors prevented staff from conducting patient therapeutic observations without opening the door and causing a disturbance. Inspectors also witnessed patients receiving personal care in their bedrooms with their doors left open, which compromised their privacy. During our previous inspection of the ward in 2018, we identified a number of areas that were compromising the privacy and dignity of patients and it was disappointing to find similar issues.

It was positive to see there were no permanent staff vacancies and at the time of our inspection, inspectors found staffing levels were appropriate to maintain patient safety. However, some staff felt there were not enough staff to meet fluctuating staff needs and increased patient demand on the ward. Staff confirmed there is a governance structure in place in terms of activities and meetings to discuss incidents, findings and issues related to patient care. However, we were not assured that the governance structure provided strong operational support, clear leadership, and accountability to ward staff.

Chief Executive of Healthcare Inspectorate Wales, Alun Jones said:

“It is positive to see the dedication from staff in providing person-centred care at Ysbyty’r Tri Chwm. Our inspection highlighted areas for immediate improvement and Aneurin Bevan University Health Board must undertake robust measures to ensure patient safety and strengthen the leadership and management systems within the hospital. We will continue to engage with the health board on their plans for improvement.”