Improvement required at a specialist Mental Health Ward at Prince Philip Hospital in Llanelli

The inspection identified several areas that required immediate improvement to ensure the safety of patients, staff and visitors. Key concerns included unsecured areas, such as fire doors wedged open, cluttered areas near fire exits, and broken handrails. While some issues were addressed during the inspection, inspectors found that stronger governance processes are needed to effectively identify and manage risks. Inspectors have recommended a full review of audit and risk management procedures.

Whilst an in-date ligature point audit process was in place on the ward, it did not detail each ligature risk, including some areas identified during the inspection. Further attention is needed to ensure staff recognise and capture all ligature risk points to maintain the safety of patients.

Further concerns were raised regarding the recording of restraint incidents. Although over 80% of staff had completed Reducing Restrictive Practices (RRP) training, the data lacked details on which staff were involved in restraint incidents, making it difficult to confirm whether only trained staff were engaging in these practices. Inspectors have recommended improvements to the record-keeping of staff involvement in these incidents to improve accountability.

Despite these concerns, staff were observed treating patients with kindness, respect, and enthusiasm. Patients provided positive feedback on the care and treatment they received, noting that staff maintained their dignity and privacy. Additionally, inspectors found that staff demonstrated a strong understanding of safeguarding procedures and reporting protocols.

Recommendations were made for a structured programme of therapeutic activities to support patients’ wellbeing and rehabilitation. Environmental improvements were also suggested, including re-positioning sensory boards, improving garden accessibility, and enhancing the overall therapeutic setting.

Training compliance was high, with 95% of staff completing Basic Life Support (BLS) training. However, Immediate Life Support (ILS) training was significantly lower at 33%. Inspectors have called for urgent action to address this gap and ensure staff receive and complete mandatory training.

A Fire Risk Assessment (FRA) from October 2023 identified several high-risk issues, including improper storage of oxygen cylinders. During the inspection we identified five oxygen cylinders that were not secured, leading to a health a safety risk. Issues were also identified in Infection Prevention and Control (IPC), including improper clinical waste storage and unlabelled food items. While staff compliance with IPC training was high, further work is needed to ensure consistent adherence to IPC standards across the ward.

Although medication management was generally robust, inspectors noted the absence of patient photographs on medication records, posing a potential risk of error. Gaps in post-rapid tranquilisation checks were also noted, highlighting the need for better record-keeping and adherence to monitoring protocols.

Staff feedback revealed concerns about communication and senior management visibility on the ward, with some staff reporting dissatisfaction and low morale. Staffing levels were a critical issue, with frequent shortfalls and heavy reliance on agency and bank staff. An establishment review has been recommended to ensure appropriate staffing levels and skillsets.

Our report includes a series of recommendations aimed at addressing these issues. We will continue to monitor the health board’s progress in implementing these improvements.

Chief Executive of Healthcare Inspectorate Wales, Alun Jones said:

This inspection highlighted areas requiring immediate improvement to ensure the safety and wellbeing of patients, staff, and visitors at Bryngolau Ward. While it is encouraging to see the dedication and compassion shown by staff, there is an urgent need to address issues related to governance, staffing levels, and the overall environment to support safe, effective care. We are committed to working with the health board to implement the necessary changes and improve patient care. Our recommendations will help strengthen staff support, improve governance, and create a safe, therapeutic environment for all.

September 2024 - Mental Health Service Inspection - Bryngolau Ward, Prince Philip Hospital