Major improvement required at a mental health facility in Pontypridd
Healthcare Inspectorate Wales (HIW) has issued a report following an inspection of the mental health services being provided at Heatherwood Court in Pontypridd, managed by the Iris Care Group.
The inspection took place over three days in December 2023, and focused on Caernarfon, Cardigan and Chepstow wards. The low-secure, locked rehabilitation hospital currently accommodates 35 people within single gender units, offering specialist mental health treatment for men and women.
Following a previous inspection in November 2022, the setting was placed within HIW’s Service of Concern process, which is used when there are significant service failures, or when there is an accumulation of concerns. During the recent inspection, an immediate assurance notice was issued due to the setting’s poor cleanliness, and inadequate lifesaving training in place for staff.
Heatherwood Court remained a Service of Concern until April 2024, but has since provided adequate assurance on the necessary improvements and has now been de-escalated from this process.
During the recent inspection, we identified poor standards of cleanliness throughout all wards, and the condition of the premises was not reflective of a modern inpatient mental health service. Cleaning schedules had numerous gaps and we could therefore not be assured that patients were being protected from healthcare associated infections.
Inspectors found committed staff who were treating patients with dignity and respect. Patients generally provided positive feedback about their experiences and were complimentary about their care and interactions with staff. It was positive to note that staff had undertaken equality, diversity, and inclusion training to help recognise the importance of treating all patients fairly. Patients had their own programme of care that reflected their individual needs and risks, they could also engage and provide feedback about their care in a number of ways.
Patients had access to outdoor spaces, health clinics, and a variety of therapeutic activities, both onsite and in the local community. However, it was disappointing to find that the Social Hub, which included facilities such as a café and shop, was no longer open. We have asked the service to consider the feasibility of reinstating the hub to provide an opportunity for patients to engage and relax.
There were established and effective governance arrangements in place to provide oversight of clinical and operation issues. Audit activities and monitoring systems helped to ensure the hospital focussed on improving. Staffing levels were appropriate to maintain patient safety within the wards at the time of the inspection. We found effective processes in place to help ensure that staff at the hospital safeguarded patients appropriately. However, staff had not received appropriate lifesaving training such as resuscitation techniques, to ensure the welfare and safety of the patients in a medical emergency.
HIW had been notified by the service of medication errors that had occurred at the hospital in the months prior to the inspection. The service had however, recently implemented an electronic Medication Administration Record (MAR charts) system and advised there had not been a medication error since the new systems implementation. Inspectors did however observe some patients receiving medication through a hatch in the clinic room door. We have asked the service to review the way medication is administered to fully protect the safety, privacy, and confidentiality of patients. Additionally, medication fridges must be locked, and daily checks of the fridge temperature must be completed to ensure that medication is being stored at the manufacturer's advised temperature.
The majority of staff said they would recommend the unit as a place to work, and that they would be happy with the standard of care provided. Some staff members however indicated that there was a poor working environment, and that they do not have enough time to give patients the care they need. Inspectors advised the service to engage with staff to further understand their views and provide assurance action is being taken.
Healthcare Inspectorate Wales Chief Executive Alun Jones said:
‘The service provides support for some of the most vulnerable people within our communities, and it is essential improvements were made. It is reassuring to hear the setting has now been de-escalated as a Service of Concern. We will continue to engage with the facility’s management company to ensure sustained progress against our findings.’