Mental health unit ordered to act over serious safety concerns

Mark Mansfield

Patients and staff were put at risk by serious gaps in safety training at a mental health unit, inspectors have found.

Healthcare Inspectorate Wales (HIW) identified low levels of mandatory training among staff at the Llanfair Unit at University Hospital Llandough, as well as longstanding problems including mould, leaking ceilings and broken toilets and showers.

The watchdog said it was not assured that enough staff had the skills needed to manage risks safely and required Cardiff and Vale University Health Board to take urgent action.

Inspectors also found staff providing kind and compassionate care, with patients treated with dignity and respect and involved in decisions about their treatment.

The inspection, carried out on June 8, 9 and 10, covered the 13-bed Meadow Ward and 11-bed Daffodil Ward, which provide rehabilitation services.

One of the most serious concerns was mandatory training.

Basic life support compliance stood at 58% on Daffodil Ward and 57% on Meadow Ward, while moving and handling training was completed by only 21% and 30% respectively.

Safeguarding Level 3 compliance was 33% on Daffodil Ward and zero on Meadow Ward, while training in strategies and interventions for managing aggression stood at 56% and 54%.

Only seven members of staff across the two wards had intermediate life support training, which HIW said was below the level needed to provide “robust assurance” because of the unit’s remote location within the hospital site.

No staff had been trained in the safe use of portable oxygen cylinders.

Inspectors also found examples of staff who were not compliant with aggression management training taking part in restraint interventions.

HIW said it was not assured enough staff had the skills required to respond safely to medical emergencies, carry out physical interventions, meet safeguarding requirements or safely move and handle patients.

The concerns were escalated through HIW’s Immediate Assurance process, requiring the health board to set out urgent measures to protect patients and staff while training gaps were addressed.

Mould and leaks

Inspectors also identified what they described as “multiple, longstanding environmental risks” on both wards.

Mould was found in bathroom areas, while toilets, showers and bathing equipment were out of order.

Other problems included damp, peeling paint, stained ceiling tiles, leaking taps, blocked or non-functioning sinks, faulty urinals, a lack of hot water and defective shower controls.

Inspectors also witnessed unresolved ceiling leaks becoming worse during heavy rain.

Staff told HIW that maintenance problems were sometimes recorded as closed on the health board’s electronic system despite not having been resolved.

HIW said this demonstrated a “persistent failure” to deal with environmental problems.

Several bedroom observation panels were also faulty, meaning staff could not always carry out observations as intended while maintaining patients’ privacy and dignity.

Only four bedrooms on each ward had en-suite bathrooms, leaving most patients dependent on communal facilities, several of which were out of use during the inspection.

Despite the concerns, inspectors found numerous examples of good care.

Patients were treated with dignity and respect and encouraged to take an active role in decisions about their treatment.

They were supported to develop independent living skills, including doing laundry, looking after their rooms and taking part in cooking activities.

Occupational therapy, exercise equipment, games, arts and crafts and planned outings were also available, while inspectors praised multidisciplinary working and discharge planning.

Medicines management was described as robust.

Sickness

Staffing levels during the inspection were sufficient to meet patients’ assessed needs, but vacancies, sickness and the regular redeployment of Llanfair staff to other wards were affecting planned rehabilitation activities and escorted leave.

Inspectors also called for stronger governance, saying there was insufficient structured senior oversight to identify trends from incidents and ensure lessons were applied across the service.

Alun Jones, chief executive of HIW, said: “Inspectors found dedicated staff providing kind, compassionate and person-centred care to patients at Llanfair Unit.

“However, significant concerns were highlighted, including safety-critical staff training, which required immediate action, alongside longstanding environmental issues that affected the privacy, dignity and wellbeing of patients.”

He said some findings reflected concerns identified during an earlier inspection of other specialist mental health wards at University Hospital Llandough.

Mr Jones added: “The health board must now demonstrate that learning is being applied consistently across services and that improvements are being sustained. We will continue to monitor progress closely.”

HIW said it was satisfied with the health board’s response to the immediate concerns and its proposed action on the wider recommendations.

‘Urgent action’

Welsh Conservative shadow health and social care minister Natasha Asghar said the findings required urgent action.

She said: “Patients receiving specialist mental health care should be able to expect properly maintained facilities and trained staff to keep them safe.

“I recognise there are some positive findings in this report, including praise for the compassion shown by staff at the Llanfair Unit, but the safety concerns must be urgently addressed.”

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