Health chiefs have been told to make "immediate improvements" to a mental health unit at Llandough Hospital.

Inspectors turned up unannounced for a three-day visit of the Hafan y Coed unit in July.

A report, published on Wednesday, revealed some issues raised during a previous inspection last year had not been addressed - including concerns over patient restraint.

Cardiff and Vale health board said the "welfare, safety and quality" of patient care was their "upmost priority".

Healthcare Inspectorate Wales (HIW) said its work focused on two adult mixed-gender wards - the crisis assessment unit on the Cedar ward and the psychiatric intensive care unit on the Alder Ward.

They found evidence of untrained staff being involved in incidents where patients were being restrained - some of which had been inaccurately recorded. The same issues were identified by inspectors in January 2023.

The unit also posed health and safety risks due to building maintenance problems, such as swollen floors that prevented fire doors from closing and several trip hazards.

The HIW report also found care teams on both wards only consisted of two types of healthcare professionals, raising concerns over a lack of "diverse expertise in decision making".

But they noted: "The staff we spoke with were passionate about their roles, and enthusiastic about how they supported and cared for the patients."

"Inspectors witnessed staff treating patients with respect and kindness and patients we spoke to generally gave positive feedback on their care. However, inspectors did witness instances where staff did not respond to patients who needed help."

The report recommended that CAVUHB should consider installing emergency assistance call points within patient bedrooms and throughout the wards.

Further staff issues included low compliance with infection prevention and control training, along with gaps in daily cleaning schedules and a lack of evidence that communal facilities were cleaned regularly.

Staffing levels were adequate on both words, although there was a high turnover of staff on the Cedar Ward, which depended on agency staff to fill vacant shifts. Ward staff had not held any meetings in the six months leading up to the unannounced inspection.

But there was a high staff compliance with mandatory training - and some workers had carried out extra voluntary training to improve their improve their awareness and understanding of equality and diversity issues.

However, clinical record keeping was good on the Alder Ward but considered poor on the Cedar Ward, and many patient intervention plans were "incomplete and not tailored to individual needs".

The Alder ward also had an activities co-ordinator on its staff giving appropriate therapeutic activities to patients - but neither ward had an occupational therapist, and inspectors did not feel assured that Cedar Ward patients could access adequate activities to support their health and wellbeing.

Each patient had their own bedroom with ensuite shower facilities,although monitor cabinets, used to observe patients without disturbance them in their rooms, were left unlocked which compromised the privacy, safety and dignity of patients.

Finally, staff who completed a questionnaire felt that senior managers at the hospital were not visible and communication with senior management was not effective.

The report adds there were well-established protocols to investigate incidents and key issues, but improvements were needed to make sure such actions were completed quickly and lessons were learned.

Alun Jones, chief executive of HIW, said: "Our recent inspection at Hafan y Coed Mental Health Unit has highlighted areas requiring immediate improvement to enhance the quality of care provided."

"It is disappointing that some areas had not improved since our previous inspections, and we will be working with the health board to ensure these issues are addressed."

"However, it is encouraging to see that the health board has already begun addressing some of these concerns, and staff were receptive to our feedback."

Reacting to the report, a spokesperson for the Cardiff and Vale University Health Board said: "The health board recognises the importance for the public and patients in having confidence in the services we provide and the integral role Healthcare Inspectorate Wales (HIW) play in providing these assurances around quality and standards of care delivered by healthcare organisations."

"As a learning organisation, we are open and fully receptive to any areas for improvement as recognised in our improvement plan."

"It is positive to see a number of the recommendations identified have already been completed since the initial visit to the crisis assessment unit (Cedar ward) and psychiatric intensive care unit (PICU) (Alder ward) was undertaken in July and that a robust improvement plan has been agreed with HIW to address any outstanding areas."

"Capital, Estates and Facilities colleagues are undertaking a comprehensive programme of exploratory work with contractors to address the maintenance issues referenced within the report. To facilitate the repair work, patients have been transferred to an alternative ward within adult mental health services to ensure services and care can continue during this time."

"While we recognise the concern raised in relation to occupational therapy, the health board is fully compliant with the 'National Minimum Standards for Psychiatric Intensive Care in General Adult Services'. Interim arrangements continue to be provided across all inpatient mental health services whilst recruitment is ongoing to these posts, while recognising there are national shortages in this professional group."

"The welfare, safety and quality of care of patients has always remained our utmost priority. To address the issue of the call bells, all patients in Hafan y Coed have a comprehensive and individual care plan that is risk assessed, and where it is considered clinically appropriate, they are provided with emergency assistance call point in line with national standards."

"We would like to reassure service users and families that mental health colleagues are fully qualified and competent in managing behavioural issues which require restraint, and the health board has taken a concerted and proactive effort to improve compliance of training and development, particularly around improving cultural competencies within equality, diversity and human rights training."

"We would like to assure service users and their families that, whilst it is sometimes necessary to physically restrain people in order to ensure their safety, this is done proportionately and is always in the context of a dignified and trauma-informed approach."

"The health board is pleased to read in the report that colleagues within mental health services are enthusiastic and passionate in the delivery of care to patients and patients shared they are treated with respect and kindness."

"We will continue drawing on the expertise and lived experience of colleagues and service users to coproduce further solutions which continually improve the services we provide."