Healthcare Inspectorate
Wales (HIW) has published its findings following an
unannounced inspection of specialist mental health services at
University Hospital
Llandough, managed by Cardiff and Vale University
Health Board.
The inspection took place over three days in March 2026 and
assessed the quality, safety and patient experience across three
wards which provide specialised care for individuals over 65 with
dementia or severe mental illnesses.
Inspectors observed compassionate, respectful interactions
between staff and patients, with care delivered in a calm way.
There was evidence that less restrictive options were considered,
and restrictions were applied proportionately. Patients were
supported to maintain their wellbeing through access to
meaningful activities and opportunities, including therapeutic
and recreational sessions. Care planning was individualised and
well documented, with strong multidisciplinary involvement and
good engagement with families where appropriate. Patients told
inspectors they felt safe and supported, and care was generally
provided in a timely and responsive manner.
However, the inspection identified several concerns relating to
patient safety, cleanliness and the condition of the ward
environment, requiring immediate action. It was disappointing to
note some of these issues had been identified during a previous
inspection, raising concerns about the effectiveness of oversight
and the health board's ability to deliver and sustain
improvement.
HIW used its immediate assurance process to seek assurances from
the health board in relation to environmental safety, ligature
risk management and infection prevention and control. This
followed significant concerns about the condition and cleanliness
of ward environments, including accessible ligature risks,
environmental hazards and poorly maintained ward areas, which did
not consistently support patient dignity or safety.
HIW was not assured that infection prevention and control
arrangements were consistently effective. Inspectors identified
widespread cleanliness issues, including dust, debris and
staining in patient areas, with toilets in some areas not cleaned
to an acceptable standard and some facilities out of use for
extended periods. There were also concerns that domestic support
arrangements were insufficient. In some cases, clinical staff
were required to undertake cleaning duties, increasing pressure
on already stretched teams.
While robust arrangements were in place for safeguarding,
incident management and care planning, inspectors found that
local audit processes were not reliably identifying or driving
improvements in key risk areas. Governance and senior leadership
oversight was not consistently effective in identifying,
escalating and addressing risks in a timely way.
Inspectors also identified workforce pressures, including gaps in
mandatory training compliance and a lack of clear guidance for
night-time staffing arrangements. These issues reduced assurance
that staff were consistently supported to maintain safe care.
The health board has since outlined actions taken and planned
improvements, including addressing safety risks, undertaking deep
cleaning, strengthening infection control, improving maintenance
and enhancing oversight. HIW will continue to monitor progress to
ensure improvements are implemented and sustained.
Alun , Chief Executive of Healthcare
Inspectorate Wales, said:
This inspection found committed staff delivering
compassionate and respectful care in challenging circumstances.
However, significant concerns were identified about the ward
environment and failure to address known risks, particularly
around cleanliness, safety and oversight. While challenges
associated with ageing mental health estates are seen across
Wales and are not unique to this service, the impact on patients
here is significant. The health board must now demonstrate clear
and sustained improvement to ensure patients are cared for in a
safe, clean and wellmaintained environment. We will continue to
monitor progress closely.
