Inspectors find safe care is being provided at Priory Tŷ Cwm Rhondda mental health hospital, but further improvement is required
Healthcare Inspectorate Wales (HIW) has issued a report (20 July 2023) following an unannounced inspection of two wards at Priory Tŷ Cwm Rhondda mental health hospital which took place over three consecutive days in April 2023. During this period a number of assessment areas were inspected within Cilliad and Clydwych Wards at the hospital.
Tŷ Cwm Rhondda is a 20-bed, low secure mental health hospital offering treatment and rehabilitation services for males with complex mental health needs. Inspectors found staff were committed to providing safe and effective care and suitable protocols were in place to manage risk, health and safety and infection control. However, improvements were required in relation to appropriate use of language by staff, record keeping and patient access to independent mental health support services.
When asked, patients spoke positively about their interactions with staff, and inspectors found staff were treating patients with dignity and respect. Inspectors observed good therapeutic relationships between staff and patients but witnessed some staff using inappropriate and unprofessional language when referring to challenging patient behaviours. Staff mandatory training completion rates were high at nearly 90%, however, the registered provider must reinforce the use of appropriate and professional language by staff and should consider providing internal values-based training in respect of this.
It was positive to find that patients, family, and carers could engage and provide feedback on the provision of care at the hospital in numerous ways. However, it was unacceptable to note that provision of Independent Mental Health Advocate (IMHA) services was limited to weekly telephone contact with no on-site visits. We recommended that the provider engages more effectively with advocacy services to ensure the provision of onsite independent mental health support services for the patients.
Patients had their own programme of care that reflected their individual needs and risks but there were no ‘Patient Status at a Glance Boards’ displayed on the wards at the time of our inspection. The registered provider must ensure that patient information can be quickly and easily accessed by all staff without compromising privacy and confidentiality.
Overall, we were assured that the service had processes in place to manage and review risks to help maintain the health and safety of patients, staff, and visitors. Patient Care and Treatment Plans (CTPs) were generally maintained to a good standard, but improvements were required to ensure that information is captured and recorded in a streamlined and consistent way to improve working practices and ensure that records can be accessed by all staff members. During the inspection it was concerning to find examples of outdated patient Positive Behaviour Support plans (PBSs), which had not been reviewed nor updated to reflect the current needs of the patients. The statutory documentation we saw verified that the patients were appropriately and legally detained. However, some improvements were required in respect of Mental Health Act governance oversight, audit processes and document completion.
Most staff told us that they feel supported in their roles and satisfied with the organisational management. However, we were informed that the separate governance systems in place for clinical and hospital staff could sometimes cause communication difficulties between both groups. During the inspection we noted that there were no formal meetings taking place to enable staff to provide feedback on their experience at the hospital.
We found that staffing levels were appropriate to maintain patient safety but there were several staff vacancies being recruited to at the time of our inspection. Recruitment of staff requires a sustained effort in order to support the delivery of safe and effective care.
Chief Executive of Healthcare Inspectorate Wales, Alun Jones said:
It is positive to see the quality of care being provided at Priory Tŷ Cwm Rhondda hospital and the dedication of its staff in delivering high standards. Our inspection did identify some areas for improvement which require the service to take action. The setting has produced a comprehensive plan which sets out improvement actions and we will continue to closely monitor their progress against this.