Archived: The Chimneys Clinic

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff completed comprehensive mental health and physical health assessments on admission and regularly reviewed these. The multidisciplinary team included a full range of specialists who worked together to develop care plans and managed care and treatment with patients to meet their individual needs. Staff supported patients so they could maximise their independence, choice and control.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

During the inspection we reviewed 6 care records. Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.

Staff developed care plans that met the patients’ needs identified during their assessment. We reviewed 6 care plans that were personalised, holistic and recovery oriented. The care plans included input from multiple external professionals alongside the multi-disciplinary teams to meet individual needs. We saw evidence of Mental Health Act and Mental Capacity Act compliance within the patient care and management records.

There was evidence of patient involvement in care planning. Care records showed a collaborative approach between staff and patients and reflected an individualised approach to care. Staff offered patients a copy of their care plan.

Whilst there was limited evidence of carers involvement in care planning from the records we reviewed, carers we spoke with told us they felt involved when patients had consented for them to be included. The service held monthly parent forums where family had the opportunity to feedback to the service or raise concerns.

Staff assessed patients’ physical health needs in a timely manner after admission. Patients’ physical health was regularly monitored and checked. We saw examples such as seizure plans and dietetic care plans within patient records.

Staff assessed patients’ communication needs with them and we saw evidence of this in patient records.

The service planned and delivered people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence.

The team included or had access to the full range of specialists required to meet the needs of patients in the service including doctors and nurses, occupational therapists, clinical psychologists, social workers, pharmacists, dieticians and support workers.

The service provided a range of activities and opportunities to help patients acquire living skills. These included for example, cooking and baking, accessing the local community such as with visits to the cinema, library trips, sports (such as swimming and the gym) and day trips by bus and train. Patients were also accessing range of educational opportunities such as functional English skills; first aid courses; budgeting skills; singing and guitar lessons. One patient was undertaking a British sign language course. One patient had been supported to successfully apply for a registered emotional support dog, another patient had begun working part time at a local charity shop and another patient had joined the local church choir and shared her artwork at local exhibitions . Patients had access to a family garden where they could grow their own food and take care of the plants.

Patients had access to a range of therapies to support them including for example art therapy, systemic therapy, psychotherapy, integrative therapy. Where possible patients were matched to therapists who could best meet their individual needs. Patients also received a weekly 1:1 session with an occupational therapist. They were supported with daily living skills such as personal hygiene and managing finances as well as emotional skills such as healthy relationships, understanding emotions, understanding grief and managing anger.

Families were also supported with systemic therapy sessions. Carers we spoke with told us how valuable this had been.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. There was a lead physical health nurse employed by the service and contracts were in place 1 day a week for a dietician and speech and language therapist when needed. A service level agreement was in place with a GP and managers told us there were good links with opticians and a dentist.

There was a robust audit programme in place. Staff participated in both local and provider wide clinical audit. Topics included topics such as, care plans; food and fluid, enhanced observations and engagement; rapid tranquilisation and section 17 leave.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers ensured that staff, including agency staff, received the necessary specialist training and had the required competencies for their roles. We reviewed the service competency list, which included a range of essential topics such as basic life support, safeguarding and medication. Also, specialist topics including understanding eating disorders, therapeutic boundaries and the development of the teenage brain.

Managers provided new staff with an induction, regular supervision and annual appraisals.

At the time of inspection, the percentage of staff that received regular supervision was 94%. The percentage of staff that had had an appraisal in the last 12 months was 90%.

Staff worked effectively across teams and services to support people, by sharing their assessment of needs when they move between different services.

Staff came together to discuss patients and held regular multidisciplinary meetings.

The teams had effective working relationships, including good handovers and regular team meetings. Staff shared information about patients at effective handover meetings within the team (for example, shift to shift). They reviewed each patient and clearly documented any changes so that staff knew about any individual risks or issues on that shift.

Staff had effective working relationships with teams outside the organisation including for example, local authority social services and GPs. There was a good relationship with local commissioners and the service sent them weekly updates by email.

The manager attended West Suffolk hospital eating disorder meetings for further specialist advice and input.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Ward activities helped promote a healthy lifestyle for patients. The service was a tobacco free hospital with designated areas on site for patients who wished to use vapes. Patients were offered smoking cessation led by nurses, there were healthy food choices and staff encouraged people to take leave to go on walks, and supported activities such as swimming and attending the gym. We saw examples in care records where patients had “keep healthy” plans in place. The occupational therapist and activity co-ordinators created individualised weekly timetable for patients based on their goals and what they hope to achieve. Patients were encouraged and supported with self-care routines.

The service routinely monitored people’s care and treatment to continuously improve it and to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service used recognised tools such as the Health of the Nation Outcome Scales (HONOS) which is a set of tools for assessing the mental health and social functioning of patients; The Short-Term Assessment of Risk and Treatability (START) which is a clinical guide used to evaluate a patient's level of risk for aggression and evaluate how likely they are to respond well to treatment and the Model of Human Occupation Screening Tool (MOHOST) which is an occupational therapy assessment used to understand a person's ability to engage in occupations.

Multidisciplinary staff worked with patients to identify long and short-term goals and objectives to work towards.

The service told people about their rights around consent and respected these when they delivered person-centred care and treatment.

There was evidence within care records of informed consent being obtained. Staff complied with the Mental Capacity Act 2005. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately.

We reviewed patients’ medication charts and saw people detained under the Mental Health Act (MHA), had been prescribed and administered medicines in line with MHA consent to treatment authorisations.