Staff praised following inspection of dementia care at Llandough Hospital
Healthcare Inspectorate Wales (HIW) has issued a report (16 June 2023) following an inspection of two specialist Dementia care wards at the University Hospital Llandough in Penarth.
Inspectors witnessed a dedicated team of staff who were committed to providing a high standard of care. Suitable protocols were in place to manage risks, health and safety and infection control, but some improvements were required in relation to updating policies and compliance with mandatory staff training.
HIW completed an unannounced inspection at the hospital on three consecutive days in March 2023. During this period a number of assessment areas were inspected within wards 12 and 16, which provide adult mental health services for older patients diagnosed with Dementia.
Assurance work during the inspection concluded that patient care and treatment plans were being kept to a good standard. There were safe and therapeutic responses in place to manage challenging behaviour and promote the safety and wellbeing of patients. Senior staff confirmed incidents of physical restraint were rare and only used as a last resort. Legal documentation to detain patients under the Mental Health Act was compliant, and overall effective procedures were in place to manage medicines safely. However, there were some gaps on both wards where temperature checks of medicine fridges had not been recorded.
When asked, staff told inspectors they were enthusiastic about their roles and how they supported and cared for their patients. Staff were engaging with patients sensitively and took time to understand their care needs. For individual meetings, patients had access to external bodies to provide further support and guidance, such as solicitors or advocacy, alongside their families and carers. Patients had access to outdoor spaces for therapeutic time, although we recommend that work is undertaken to improve the appearance and safety of the garden.
There were opportunities for patients, relatives, and carers to provide feedback on the care provided, and senior ward staff confirmed they aim to resolve complaints immediately. There was, however, no evidence of regular patient meetings taking place, which would provide an opportunity to discuss any improvements. The health board confirmed they were aiming to re-introduce carers groups and are recruiting peer support reviewer roles, all of which will help to improve quality of care for patients.
Ward staffing levels appeared appropriate to support the safety of patients within the hospital at the time of our inspection. However, we were advised that there have been times when the staffing numbers have been below the required level. This was due to several factors; agency staff being booked but not turning up for duties, and agency staff not being familiar with the complex needs of the patient group.
Staff wore personal alarms which they could use to call for help if needed. There were also nurse call points around the hospital, and within ward bedrooms and bathrooms, so that patients could summon aid if needed. We identified that some patient call buttons were not within reach from the bed areas.
During our time on the ward, we observed a positive culture with good relationships between staff who were working well together as a team. Staff described ward managers and deputies as always being approachable and accessible, and there appeared to be a strong and supportive leadership culture on both wards. However, most staff stated that they would like more visibility, support, and engagement with the senior management team.
We were provided with evidence that staff had been booked on to mandatory training courses, however, the health board must continue to ensure that compliance figures are improved. Training figures indicated that improvements are required, with a 66% overall compliance with mandatory training on Ward 12 and nearly 51% on Ward 16. In addition, fire safety training on Ward 12 was low at nearly 22% and safeguarding children on Ward 16 was low at just over 24%.
We were provided with a range of policies, however, upon review most of the versions we received had passed their review date. These included restraint policies, the procedure for NHS staff to raise a concern and prevention and management of violent and aggressive situations.
Arrangements were in place to quickly share information and lessons learnt with staff from complaints and incidents at the hospital and the wider organisation. This helps to promote patient safety and continuous improvement of the service provided.
Chief Executive of HIW, Alun Jones said:
‘It was pleasing to find that Staff ward staff are clearly passionate about their roles and patients overall are receiving a good level of care. Our inspection identified some areas for improvement, particularly the continued need to focus on improving staff mandatory training. Cardiff and the Vale University Health Board has produced a plan which sets out improvement actions as a result of this inspection.’