Inspectors find immediate improvement is required at a specialist mental health hospital in Wrexham
Healthcare Inspectorate Wales (HIW) has issued a report (7 March 2023) following an inspection of the independent mental health hospital, Tŷ Grosvenor in Wrexham. The service provides specialist care for men over the age of 18 with mental health conditions and/or personality disorders.
HIW completed an unannounced inspection at the hospital on three consecutive days in November 2023. The inspection focused on two wards, the Alwen Ward and the Brenig Ward.
Through our concerns process, we received a report of the hospital having inadequate procedures in relation to the management of medication. Following a subsequent inspection of the hospital, HIW placed Tŷ Grosvenor into its Service of Concern process in November 2023. This process is part of HIW’s Escalation and Enforcement procedures which aim to ensure that rapid action is taken when there are significant service failures, or when there is an accumulation of concerns about a healthcare setting.
The inspection uncovered multiple issues requiring immediate assurance due to issues of non-compliance around the application of the Mental Health Act, including incorrect recording of medication being administered to patients. Following our findings, the hospital voluntarily stopped the admission of new patients pending completion of an internal review.
We continued to engage with Elysium Healthcare, the management company of Tŷ Grosvenor to seek further assurances, and in January 2024 we were satisfied adequate improvement had been made. The hospital was then de-escalated as a Service of Concern.
During the inspection in November, we were concerned to find instances where documentation was not compliant with the Mental Health Act. Concerns included capacity assessments not always being undertaken to determine whether patients had the mental capacity to consent to treatment. Some patients at the hospital had been prescribed medication without the statutory certificate of consent form in place to authorise the treatment.
Our assurance work found patients at the hospital had been prescribed types, or doses of medication, that had not been listed on the statutory certificate of consent form in place to authorise the treatment. Nursing staff had administered medication to patients without checking that the type and dosage had been consented to, or which hadn’t been authorised by a Second Opinion Appointed Doctor. Discrepancies between the medication being administered to patients and the medication stated on their certificate of consent forms identified by the external pharmacy had not been rectified by the hospital in a timely manner. The clinical audits undertaken internally by hospital staff had also not been effective in identifying these discrepancies.
Inspectors found there were governance arrangements in place, such as audit activities and monitoring systems, to help provide oversight of clinical and operational issues. However, we were not assured that these processes were effective, as they were not helping the hospital meet best practice and legislative requirements.
Despite this, inspectors found suitable procedures were in place for the safe management of medicines, with medication fridges locked when not in use, and regular stock checks being undertaken.
Patients could engage and provide feedback in a number of ways, including support with any issues they may have regarding their care. Patients were being kept informed about their rights and supported to apply to the Mental Health Review Tribunal to have their detention reviewed. Inspectors found effective processes were in place to help ensure that staff at the hospital safeguarded patients appropriately.
When asked, patients were complimentary about the care being provided, telling inspectors they felt safer, which was an improvement since our last inspection at the hospital in July 2022. We noted an area of good practice, with one member of staff on each shift being allocated the role of security lead and taking responsibility for ensuring all staff are wearing their personal alarms, and that items such as cutlery are accounted for.
Inspectors observed staff interacting and engaging appropriately with patients and treating them with dignity and respect. During the inspection we saw examples of staff respecting the privacy of patients by knocking their door before entering.
The feedback provided by staff was generally positive with most agreeing that they would be happy with the standard of care provided for their friends or family. Mandatory staff training compliance rates were high; however, the service must ensure that all staff are kept informed about incidents and any lessons learned.
Chief Executive of HIW, Alun Jones said:
‘Our inspectors identified immediate concerns in relation to breaches of the Mental Health Act, which is in place to support some of the most vulnerable people. It is reassuring, however, to see improvements have been made since our previous inspection of Tŷ Grosvenor Hospital, which has now been de-escalated as a Service of Concern. We will continue to engage with the hospital’s management company to ensure the progress against our findings continues now and in the future.’