The visits uncovered environmental concerns including peeling paintwork, damaged flooring and damp patches as well as broken equipment
04:10, 12 Feb 2026Updated 06:09, 12 Feb 2026
The Cwm Seren mental health unit on the site of Hafan Derwen Hospital, Carmarthen(Image: Google Maps)
Unannounced visits to specialist hospital wards specialising in helping people with complex mental needs found many environmental and safety risks.
The Healthcare Inspectorate Wales (HIW) visits to Cwm Seren low secure unit (LSU) and psychiatric intensive care unit (PICU) in Carmarthen, part of Hywel Dda University Health Board, uncovered environmental concerns including peeling paintwork, damaged flooring and damp patches as well as broken equipment.
The health inspectorate has today published its inspection report in full which also reveals access to exercise for patients was limited and the outdoor facilities including the garden area at the wards posed risks of falls.
The inspection carried out over three days in November focused on care provided on the two specialist wards which support people with complex mental health needs in secure environments.
Patients did tell inspectors they felt safe and many described staff as kind, helpful and supportive, although the report stated how patients also highlighted areas where patient experience requires improvement, particularly around dignity, respect and active listening.
Some raised concerns about uncomfortable mattresses for long‑term stays as well as limited and repetitive meal variety. Inspectors noted that people who were unable to leave the ward often experienced boredom due to a lack of structured activities, contributing to a less therapeutic daily routine.
Inspectors observed paintwork peeling from the walls, floors damaged, damp, broken equipment and also found a bathroom being unaccessible to patients because it was being used for storage.
Access to physical activity was also limited. Most gym equipment was out of order and there were not enough gym‑trained staff to support safe exercise, the reports says.
The report adds that the garden area was poorly maintained with overgrown grass and slippery surfaces that posed a risk of falls and limited outdoor activity. These issues reduced opportunities for physical activity, it says – an important component of mental health recovery which should have been recognised in such a setting.
Safety issues were also identified such as an expired fire safety blanket in the LSU beverage area and an expired oxygen cylinder in the PICU clinic which were immediately removed and replaced during the inspection.
Staff were described as hardworking, caring and resilient, and systems for managing risk, incident reporting and care planning were considered “generally strong”.
Inspectors noted good reductions in restraint with staff focusing on early intervention and ensuring safe, compassionate practice when restraint was necessary.
However, compliance with mandatory training, especially basic life support, immediate life support and physical restraint training, remained below expected standards, it stated.
Additionally it added that the wards had been without a psychologist for more than two years, limiting access to therapeutic interventions and psychological assessments.
The report states: “While the staff demonstrated strong commitment and compassion, significant improvements are required to address environmental and safety risks, improve training compliance, and strengthen patient experience. The health board has been asked to act promptly on these recommendations and ensure progress is closely monitored.”
Chief executive of Healthcare Inspectorate Wales Alun Jones said: “Staff at Cwm Seren are clearly committed to providing safe and compassionate care in what can be very challenging circumstances.
“While we saw some positive practice and strong teamwork, our inspection identified environmental, safety and patient‑experience issues that must be addressed urgently.
“We expect the health board to take prompt action to improve the therapeutic environment, strengthen staff training, and ensure patients receive the consistently respectful, engaging and recovery‑focused care they deserve. We will continue to monitor progress closely.”
Director of nursing, quality and patient experience at Hywel Dda University Health Board Sharon Daniel said: “We welcome the findings in the Healthcare Inspectorate Wales (HIW) report into Cwm Seren low secure unit (LSU) and psychiatric intensive care unit (PICU) and take on board all the comments and recommendations made.
“We fully recognise both the positive practice identified and the clear areas where improvement is required across Cwm Seren. I am pleased to see that the report praised staff for providing safe and compassionate care in what can be challenging circumstances. It also notes positive practices and strong teamwork.
“I was particularly pleased to read that patient feedback during the inspection said that those we care for feel safe and able to communicate effectively with staff who they described as kind, helpful and attentive.
“The report also notes that patients said that they are happy at the hospital and describe staff as kind and helpful with strong mutual respect between staff, patients, and families or carers.
“However, the inspection identified a number of areas where we must do better, particularly around patient experience, the therapeutic environment, estates issues, access to meaningful activities, and compliance with mandatory training.
“A comprehensive improvement plan is already in place, and several key actions are underway. These include strengthening the ways in which patients feed back to us and offering every patient the opportunity to complete an interests and hobbies profile to support a more therapeutic and engaging daily routine.
“We have ordered new equipment in the gym and staff will undertake gym instructor training. New mattresses have been ordered and we have introduced improved meal choices. Repairs and maintenance work is ongoing and fire safety arrangements have been strengthened.
“Thank you to our staff who continue to work with professionalism, compassion and dedication every day. Together, we are determined to ensure they have the right tools, training and environment to provide the high‑quality care our patients deserve.”
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