The Chimneys Clinic

Updated 19 July 2023

The Chimneys is a 12-bed rehabilitation service that offers 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 service was no longer admitting patients with a learning disability. The service had a psychologically informed environment model of care. At the time of this inspection, there were 7 patients being cared for at The Chimneys. All the patients at the service were detained under the Mental Health Act.

The Chimneys Clinic has been registered with the Care Quality Commission under its current provider since 14 March 2018 for:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983

• Treatment of disease, disorder or injury

The service had a registered manager who commenced in post in October 2022, replacing the previous registered manager.

This service was previously inspected, for the first time, in March 2022.

The CQC took enforcement action following the previous inspection and issued a warning notice, which informed the service that the quality of the care they were responsible for fell below what is legally required, for the following breach of the Health and Social Care Act 2008 (Regulated Activities) 2014:

Regulation 12 - safe care and treatment - 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. We told the provider they needed to take immediate action to rectify this.

Following the last inspection, the service employed a new hospital director and implemented an action plan. The service received additional support from local commissioners who provided regular oversight.

We found improvements at this inspection and the warning notice was met.

At the previous inspection, the provider was found to be in breach of the following regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and requirement notices were issued in respect of:

Regulation 12 – safe care and treatment

Regulation 9 – person-centred Care

Regulation 10 – dignity and respect

Regulation 17 – good governance

Regulation 18 - staffing

At this inspection the provider was found to have made significant improvements and the service was no longer in breach.

What people who use the service say

As part of our inspection, we spoke with 4 patients at the service and 3 carers, and they gave very positive feedback about the service.

• Patients we spoke with told us it was the best hospital they had ever been in. They told us that staff were consistently kind and caring, really invested in their recovery and they felt truly supported and believed in.
• Patients told us their care was individualised, and they were given clear explanations regarding their treatment including the benefits and potential side effects of medication.
• All the carers we spoke with told us they felt the communication with the service was excellent, that support for carers had much improved, their loved ones were receiving excellent care and they had seen improvements in their mental and physical wellbeing.
• 1 carer told us that her loved one ‘is doing amazingly - The Chimneys have made such a difference’. All the carers were extremely pleased with the amount of education and varied activities their loved ones had access to.
• All the carers and patients we spoke with were having family therapy and they all spoke about how beneficial this had been; One carer told us ‘I wouldn’t be where I am if I hadn’t had that therapy - it’s fantastic.’

Updated 19 July 2023

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.

Updated 19 July 2023