The Care Quality Commission
  • Mental Health
  • Independent mental health service

The Chimneys Clinic

Overall: Outstanding read more about inspection ratings

Rougham, Bury St Edmunds, Suffolk, IP30 9LR (01284) 220210

Provided and run by:
The Chimneys Limited

All Inspections

23 May 2023

During a routine inspection

The Chimneys is a long-term high dependency 12-bed rehabilitation service that describes itself as offering specialist care designed to support women who have a diagnosis of a Personality Disorder (PD) or an Emotionally Unstable Personality Disorder (EUPD). Individuals with other mental health problems and young women who are transitioning from Child and Adolescent Mental Health Services were also considered for this service. The Care Quality Commission expects that high dependency rehabilitation services should support patients to re-engage with families and communities’ thorough assessment, engagement, maximising benefits from medication and reducing challenging behaviours, with the support of a full multi-disciplinary team. The recovery goal for patients is to move on to a community rehabilitation unit or supported accommodation in their own local area.

Our rating of this location improved. We rated it as outstanding because:

  • Feedback from people who used the service and those who were close to them was exceptionally positive about the way staff treated people. Everyone said that staff went the extra mile and the care they received exceeded their expectations. Patients felt empowered in their treatment. Patients told us their treatment was individualised, and that staff listened to their choices. We observed staff interacting with patients and family members in a respectful, kind, and supportive manner. Safe innovation and positive risk taking was celebrated. There was a strong person-centred culture. Patients were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally by an exceptional and distinctive service.
  • Staff took a truly holistic approach to assessing, planning, and delivering care and treatment to people who used the service. Staff reviewed, and updated care plans regularly and looked at everyone’s strengths. Patients co-produced their care plans and care plans reflected their own words. The range of treatment options included those recommended by national guidance for rehabilitation services. Managers and staff championed positive risk taking and focused on ways in which safety and outcomes for clients could be improved, including offering a wide range of education and vocational opportunities and offering all patients and families individual and family therapy. Patients were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
  • The continuing development of staff skills, competence and knowledge were recognised as being integral to ensuring high quality care. Staff were proactively supported to acquire new skills and share best practice. All staff had completed their mandatory training, received regular supervision, and had received an annual appraisal. Staff were committed to working collaboratively and used the multidisciplinary team innovatively and efficiently to deliver joined up care and share knowledge and expertise which benefitted patients.
  • Staff were consistent in supporting people to live healthier lives, including identifying those who needed extra support, through a targeted and proactive approach to health promotion and prevention of ill-health, and they used every contact with people to do so. For example, the service had an obesity strategy and provided effective support to patients who wished to lose weight. Several patients, who had expressed a desire to do so, had been supported to lose weight whilst at the service which had a positive impact on their physical and mental wellbeing.
  • The service worked to a recognised model of mental health rehabilitation. The involvement of other organisations and the local community was integral to how the service was planned and ensured that the service met people’s needs. Following admission, patients co-produced their care plans to include clear goals and discharge plans and patients demonstrated positive outcomes by moving on to more independent living within the community. There was a holistic approach to planning people’s discharge, transfer or transition to other services, which was done at the earliest possible stage. Since the last inspection, 6 patients had been discharged with 1 patient moving to independent living within her own flat, 2 patients moving to supported accommodation and all patients moving closer to their home area. At the time of inspection, 3 out of 7 patients were due to be discharged within the following 6 months into agreed community placements or supported accommodation. The average length of stay at The Chimneys was 20 months which is within the length of stay of 1 to 3 years recommended for rehabilitation services.
  • There were consistently high levels of constructive engagement with staff. Day and night staff had access to weekly team meetings, reflective practice sessions, a multi-disciplinary team ‘drop-in’ and carried out weekly, monthly and quarterly internal and external audits, which covered all aspects of service provision. Staff at all levels were actively encouraged to raise concerns.
  • Managers had an inspiring shared purpose and motivated staff to succeed. Members of the senior management team were visible within the service. The hospital director had successfully inspired and re-motivated staff since the last inspection and involved patients and carers to implement improvements and innovations, including undertaking clinical audits, the co-production of care plans, increasing the amount of therapy and activities available to patients, supporting positive risk-taking, successfully implementing the obesity strategy, improving support for carers and encouraging clear direction to further improve treatment and patient experience at The Chimneys. Staff felt positive and passionate about their roles and the patients they were supporting. Staff now felt valued, positive, and proud about working for The Chimneys.

8 - 17 March 2022

During a routine inspection

The Chimneys Clinic is a 12-bedded rehabilitation unit for adult women with a personality disorder and disordered eating or high functioning autistic spectrum disorder.

This was the first inspection of this service. We rated it as requires improvement because:

  • The service had completed a fire risk assessment in March 2021 that identified significant actions required to meet fire safety standards. However, these actions had not been completed.
  • The service had completed an environmental risk assessment but had not identified that the clinic room door was not secure enough to prevent patients accessing the clinic room.
  • The clinic room was visibly dirty.
  • Staff had not completed checks to ensure equipment in the emergency bag was working and equipment had been moved from the clinic room.
  • Managers had not completed clinical audits.
  • Staffing levels on the ward were safe. However the provider had not considered the gender mix of staff to ensure that female staff were allocated to observations. This is particularly important for patients who have experienced trauma and/or express a preference to be supported by female staff.
  • There were not enough specialist staff in place. There was no occupational therapist in post, no locum cover for the psychologist post and the therapist posts were part time.
  • Supervision and appraisal levels were low but improving. The provider was implementing a plan to improve this.
  • Staff could not be released from the ward to attend specialist training and reflective practice sessions.
  • Patients could not access drinks without staff providing them.
  • Patients could not lock their bedroom doors and did not have safe storage facilities in their bedrooms. Staff stored patients’ valuable possessions in a safe in the nursing office. however, patients had possessions go missing from both their bedrooms and the safe.
  • Provider governance systems had not identified the risks we found on inspection and where risks had been identified action had not been taken to reduce these.

However:

  • Staff regularly reviewed the effects of medications on each patient’s physical health.
  • Staff followed national guidance about ‘Stopping over medication of people with a learning disability or autism’ and had successfully reduced medicines for some patients.
  • Staff assessed and managed clinical risks to patients and themselves. Staff completed thorough assessments of patient risks and updated these regularly.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed.
  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Patients told us that they were involved in their treatment and were kept informed about changes in their medication and care.
  • Staff supported patients to maintain relationships with family and friends, and the integrated therapist worked with family members and patients to improve their relationships.

A warning notice was served to the provider due to their failure to ensure the safety of their premises and the equipment within it. The provider had identified several failures of fire regulations in March 2021 and had not acted to rectify this. This put patients, staff and visitors at risk.