Inspectors find cleanliness and safety failings on mental health wards

Mark Mansfield

Inspectors ordered urgent improvements after finding dirty toilets, apparent faecal contamination and safety hazards on mental health wards for older people at a south Wales hospital.

A report by Healthcare Inspectorate Wales (HIW) found patients on specialist mental health wards at University Hospital Llandough were being treated with kindness and respect by staff, but uncovered serious concerns about cleanliness, maintenance and the way risks were being managed.

The watchdog demanded immediate assurances from Cardiff and Vale University Health Board after inspectors found conditions that could put vulnerable patients at risk.

Among the problems identified were what appeared to be faecal matter on walls and floors, dusty and dirty patient areas, damaged ward facilities, features that could potentially be used by patients to harm themselves, and toilets that had not been cleaned to an acceptable standard.

Inspectors also found some outdoor patient areas contained bird droppings, cigarette butts, algae and tools that could be accessed by patients.

The inspection, which took place over three days in March, examined three wards caring for people aged over 65 living with dementia or severe mental illness.

HIW said some of the problems had already been identified during an earlier inspection, raising concerns about why they had not been fully addressed.

The report states that the recurrence of previously identified issues raised “significant concern” about the effectiveness of local checks and management oversight.

Inspectors found widespread cleanliness issues throughout the wards, including dust, debris and staining in patient areas. Some toilets were not being cleaned to an acceptable standard, while one toilet had been out of use for a prolonged period.

There were also concerns that there were not enough cleaning staff, with clinical staff sometimes having to carry out cleaning duties themselves, adding pressure to already stretched teams.

HIW said managers were not always identifying and addressing problems quickly enough, with local audits failing to pick up a number of issues encountered by inspectors.

The report also highlighted workforce pressures, including gaps in mandatory staff training and a lack of clear written guidance for some night-time staffing arrangements.

Despite the concerns, inspectors praised ward staff for the care they provided.

Patients told inspectors they felt safe and supported, while staff were observed treating patients with compassion, dignity and respect.

Patients also had access to a range of therapeutic and recreational activities designed to support their wellbeing, while care plans were found to be personalised and well documented.

Safeguarding arrangements, incident reporting systems and multidisciplinary working were also praised.

However, HIW concluded that failures in oversight and the condition of the ward environment meant urgent improvements were needed.

‘Significant concerns’

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said: “This inspection found committed staff delivering compassionate and respectful care in challenging circumstances.

“However, significant concerns were identified about the ward environment and failure to address known risks, particularly around cleanliness, safety and oversight.

“While challenges associated with ageing mental health estates are seen across Wales and are not unique to this service, the impact on patients here is significant.

“The health board must now demonstrate clear and sustained improvement to ensure patients are cared for in a safe, clean and well-maintained environment.”

Cardiff and Vale University Health Board has told HIW it has already taken action to address the concerns, including carrying out deep cleaning, tackling safety risks, improving infection control measures and strengthening monitoring arrangements.

HIW said it would continue to monitor the service to ensure improvements are delivered and sustained.