Archived: AdAstra

Updated 18 April 2017

Adastra is registered to provide care and treatment for people with a drug addiction. The service operates during the day and evening and does not provide accommodation for clients. The service provides substitute medicines and counselling to patients.

Adastra is registered to provide: Diagnostic and screening procedures and treatment of disease, disorder or injury.

A registered manager was in post at the service.

The service provides care and treatment to 148 private clients from inside and outside of London. All the clients paid for their treatment privately. No NHS or local authority commissioned services from Adastra.

We have inspected Adastra five times since 2010. At the last inspection in March 2016, we proposed to cancel the provider’s registration. This means the provider would no longer be able to operate the service. Following the inspection in March 2016 the provider submitted an action plan to CQC, with updates on progress on 11 May and 10 June 2016. The action plan and update outlined how the provider intended to address the concerns identified. The providers action plan and update did not address all of the concerns identified during our inspection and did not include clear timescales by which improvements would be implemented.

Updated 18 April 2017

We do not currently rate independent standalone substance misuse services.

As a result of an inspection in March 2016 CQC proposed to cancel the provider’s registration, which means that the provider would no longer be able to operate the service. The focus of this inspection was to check the progress the provider had made in addressing the breaches identified at the previous inspection in March 2016 and to provide updated information to the First Tier Tribunal hearing the providers appeal against the cancellation of their registration.

We found:

The majority of clients were prescribed medicines in excess of the dose recommended by best practice guidance (Drug misuse and dependence: UK guidelines on clinical management [orange book], Department of Health [DH], 2007), were prescribed medicines to be injected or were prescribed medicines not licensed for the treatment of substance misuse. Best practice guidance (DH, 2007) indicates that doses prescribed in excess of guidelines may not be effective and their prescription would be exceptional. Guidance (DH, 2007) also indicates that clients receiving injectable medicines should be closely supervised. Where prescribed medicines are not licensed for the treatment of substance misuse best practice indicates that systems and governance processes should be in place to ensure that treatment is effective and safe. The provider did not have appropriate systems in place to ensure that medicines prescribed in high doses, in injectable forms or off license were safe or effective.

The provider’s contact with GPs was not consistent or systematic. Seventy five percent of the 16 client treatment records we looked at in full showed that required physical health checks had not been completed by the provider, or obtained from the clients’ GPs. This included electrocardiograms (ECGs) which may be required to detect potentially fatal heart abnormalities. This meant that some client’s health and safety remained at significant risk.

The provider did not have appropriate arrangements in place to ensure that missing assessment information for existing clients had been obtained. Sixty five percent of the clients whose records we reviewed had not had the risks associated with their treatment comprehensively assessed and management plans put in place. Risk assessments had not been systematically reviewed since the previous inspection and were not updated regularly. This meant that treatment decisions were based on incomplete client information which posed a risk to their health and safety.

The provider did not have arrangements in place to ensure that clients were seen every three months by the prescribing doctor, in line with best practice guidance (DH, 2007). Eighteen clients had not been seen face to face by the doctor who was prescribing medicines for them. The provider’s system for producing and checking prescriptions was not safe as there was a risk that clients could receive an incorrect prescription that could present a risk to their health and safety. The provider had not put appropriate arrangements in place to ensure that existing clients who may benefit from being supervised whilst taking their prescribed medicines were able to access this.

The majority of staff did not receive regular supervision or appraisal. Limited progress had been made in identifying what training staff needed to complete or regularly update to provide safe care and treatment to clients. There was a risk that staff would not develop their skills and knowledge and be able to meet the needs of clients. There was also a risk that staff would not be aware of recent changes in best practice.

The provider’s governance systems and controls to assess, monitor and improve the safety and effectiveness of treatment remained poor or absent. The provider had not been able to effectively and systematically, respond to and address, the concerns identified at the previous inspection in March 2016.

We also found:

The provider had made some progress in addressing some concerns raised at the previous inspection in March 2016. However, further improvements were identified as being required in many of these areas and the provider could not be sure that the changes made were embedded into practice and would be maintained. The improvements that had been achieved had not significantly improved the safety or effectiveness of the service provided.