Inspectors raise concerns about the care environment at specialist mental health hospital

Nation.Cymru staff

Healthcare Inspectorate Wales (HIW) has published a report following an inspection of a medium secure mental health service, which raised concerns about the condition of the care environment.

The report was into Caswell Clinic in Bridgend, which is managed by Swansea Bay University Health Board. The clinic is based within Glanrhyd Hospital, where the wider estate is owned by Cwm Taf Morgannwg University Health Board.

The inspection focused on the quality and safety of care provided to patients, and how well the service supports dignity, safety and therapeutic recovery.

Inspectors found that patients generally reported positive experiences of care and felt supported by kind and respectful staff. Inspectors also found examples of person-centred care, effective multidisciplinary working, and good oversight of Mental Health Act requirements. However, significant concerns were raised about the condition of the care environment and aspects of safety and security.

During the inspection patients said they generally felt safe on the wards and knew how to raise concerns if needed. Inspectors observed respectful interactions between staff and patients, and found a strong focus on patients’ physical health, including comprehensive assessments, routine monitoring, and access to GP and preventative services. Care and treatment planning was largely person‑centred, with effective multidisciplinary working and good oversight of Mental Health Act requirements.

The inspection also identified areas of good practice, including effective medicines management, and a clear emphasis on de‑escalation and least‑restrictive approaches.

Mental Health Act monitoring arrangements were robust, and patients had access to advocacy and information about their rights. Staff described ward-level leaders as approachable and supportive in day-to-day practice. Additionally, inspectors also noted areas of good practice such as the on‑site dental suite, providing a high‑quality and timely service to patients.

However, inspectors raised significant concerns about the physical environment, finding that the environment was unacceptable for a medium secure mental health service, and that it did not support safe, dignified and therapeutic care.

Environmental deterioration 

Inspectors observed clear evidence of environmental deterioration both internally and externally, including water damage, damaged woodwork, temporary flooring repairs, and outdoor furniture and structures that were unsafe or in poor condition.

The condition of gardens and outdoor spaces limited their therapeutic value, with escorted access required because of known hazards. These long-standing estate and maintenance issues increased infection prevention and control risks, placed additional pressure on staff, and reflected concerns previously identified through earlier HIW inspections and other external reviews.

HIW has since engaged with Cwm Taf Morgannwg University Health Board, which owns the Glanrhyd estate, and received assurance that capital funding has been secured and responsibilities for remedial works clarified. However, these issues will take time to resolve fully, and it remains essential that patients are cared for in an environment that is safe and therapeutic.

Inspectors also identified inconsistencies in routine safety and security checks. These included gaps in records of emergency equipment checks, incomplete security checklists, and incomplete ligature alarm checks, particularly out of hours.

Immediate safety concerns

Two immediate safety concerns were escalated during the inspection and addressed at the time. Inspectors found that some bedroom observation panels had been covered, which reduced staff’s ability to observe patients.

Inspectors also identified inconsistencies in the storage and accessibility of ligature risk equipment across wards, which could have delayed staff response in an emergency. This was raised with senior leaders, and immediate action was taken to improve storage arrangements and ensure the equipment was clearly visible and readily accessible.

Further areas for improvement included infection prevention and control issues linked to the environment, issues with laundry facilities, and reliance on paper-based records, which increased workload and duplication.

Some patients said restrictions on mobile phone use limited their contact with family and support networks, which they felt affected their wellbeing and recovery. Inspectors also highlighted the need to strengthen staff training, improve communication and leadership visibility, and ensure learning from incidents and patient feedback is shared consistently across the service.

HIW has set out clear expectations for improvement and will continue to work with Swansea Bay University Health Board to seek assurance that the required actions are implemented and sustained. HIW will monitor progress to ensure that patients receive care in an environment that is safe, dignified and supports their recovery.

Serious concerns 

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said: “Our inspection found dedicated staff working hard to provide respectful and person‑centred care, and it was positive to hear that many patients felt safe and well supported. However, we also identified serious concerns about the physical environment and aspects of safety and security that require urgent and sustained improvement.

“While we recognise that pressures associated with ageing mental health estates are not unique to Caswell Clinic and are evident in other services across Wales, this does not mitigate the impact on people receiving care at this service.

“Although it was reassuring that immediate action was taken to address some risks during the inspection, we expect the health board to demonstrate clear progress in addressing the wider issues identified to ensure patients receive care in an environment that is safe, dignified and supports their recovery.”