Report praises staff but reveals improvement is required within a specialist mental health ward at Ystradgynlais Hospital
Healthcare Inspectorate Wales (HIW) has issued a report (4 May 2023) following an inspection of the Tawe Ward, which specialises in mental health care at Ystradgynlais Community Hospital.
Inspectors found staff were motivated and committed to providing a high standard of care to patients, and there were adequate processes in place to manage risk, health and safety and infection control. However, improvements were required in relation to updating patient care plans, policies and risk assessments, the security of patient records and staff compliance with mandatory training.
HIW completed an unannounced inspection at the hospital on three consecutive days in January 2023. During this period, a number of assessment areas were inspected within Tawe Ward, which provides mental health services for older adults of both genders.
Inspectors witnessed staff interacting and engaging respectfully with patients and their visitors. Staff were dedicated and had a good understanding of patient needs, with ward visitors also speaking highly of the care being provided.
There was low compliance with mandatory training, staff supervision, and appraisals, plus a lack of regular internal meetings. There was also no evidence of regular patient feedback meetings taking place, which would provide an opportunity to discuss any additional requirements. The ward’s outdoor spaces and conservatory room require upgraded safety measures and appearance, to allow patients to utilise the areas therapeutically to aid their well-being.
Inspectors found patient care plans were not being regularly assessed and monitored to identify and manage risk relating to safe patient care. Risk assessments were not up to date or comprehensive enough to enable a member of staff who does not know a patient to be confidently aware of any risks. This would be of particular concern for an agency member of staff attending the ward for the first time, where it would be very difficult for them to understand patient behaviours and the appropriate actions to take.
When reviewing patient records inspectors saw evidence that patients were receiving appropriate physical assessments upon their admission, as well as ongoing physical health checks. However, patient records and identifiable data were not always kept securely to ensure that confidentiality was maintained. Medication was being securely stored, and staff were locking the clinic room and medication cupboards to prevent unauthorised access. There is an established electronic system in place for recording, reviewing, and monitoring patient safety incidents and staff confirmed that de-brief meetings do take place to review lessons learnt.
Inspectors did note that staff were not wearing personal alarms and as there is no immediate psychiatric emergency response available other than on the ward, this presented a risk to staff and patient safety. Inspectors also discovered access to the hospital out of hours was difficult, the call bell was not working, and the outside wall mounted phone was in a poor condition. The health board must ensure that these are fixed or replaced.
Chief Executive of HIW, Alun Jones said:
It is positive to see the dedication and commitment of staff to deliver such high standards of care within Tawe Ward. Our inspection did identify areas for improvements which will require resolution to improve the quality of care for patients. Powys Teaching Health Board has produced a plan which sets out improvement actions as a result of our inspection and assurance work. HIW will monitor the health boards progress against this plan.