The Care Quality Commission
  • Community
  • Community substance misuse service

Archived: AdAstra

337 Caledonian Road, Islington, London, N1 1DW (020) 7609 3172

Provided and run by:
Adastra Treatment Centre Limited

All Inspections

1, 2 & 3 February 2017

During a routine inspection

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.

8, 11 and 22 March 2016

During an inspection looking at part of the service

This was an unannounced, focussed inspection. We looked at whether areas of the service were safe, effective and well led. We undertook this inspection due to information of concern we had received.

Following this inspection we took enforcement action to cancel the registration of the provider. This means the provider will no longer be able to operate the service.

We found:

  • The premises were unsuitable for providing care and treatment. The service was not clean. Basic infection control practices and procedures were not followed.

  • Patients did not always have a physical examination before treatment. The doctor did not always assess patients before prescribing medicines. The initial doses of medicines prescribed to patients were not safe. Patients were not monitored appropriately at the start of their treatment.

  • Patients risk assessments highlighted potential risks. These risks were not explored sufficiently. Patients did not have risk management plans. There was a lack of effective safeguarding procedures and practices. The risks to patients and their children were not assessed effectively.

  • Some medicines were past their expiry date. There was no system of regular medicine checks or audits. There were no regular checks of medical equipment. Medical equipment had not been calibrated. Disposable medical equipment was past it's expiry date.

  • A staff member carried out medical investigations and provided treatment. They did not have the skills and experience, or qualifications to do so. Staff did not receive supervision or an annual appraisal. There was no list of mandatory training stating which training staff needed to undertake.

  • There was a lack of pre-employment checks for staff members. One staff member had a Disclosure and Barring Service (criminal records) check. Staff did not have employment references.

  • There was no effective system to underpin safe, effective and high quality care.

9 July 2013

During a routine inspection

The service provides a prescribing and psychotherapy service for 135 people with drug dependence issues. The provider told us that at at the time of the inspection, approximately half of the people using the service were on a maintenance dose of medication, and the remainder on a reducing dose of medication. The rate of detoxification was 14% in the past year.

We found that the service had recently appointed a new medical director.

People who use the service told us that they were given good advice on detoxifying and that they had a comprehensive review with the prescriber every three months, with informal discussions taking place monthly with non-medical staff.

We saw that the new prescriber had been liaising effectively with people's own GPs. The majority of people being treated had given consent for their GPs to be informed. We saw that before people were accepted for treatment, a comprehensive assessment was carried out.

Staff were supported to deliver support and treatment to an appropriate standard.

We found that the provider had carried out a comprehensive review of the views of people who use the service. This had led to the production of an action plan to implement identified improvements to service delivery.

20 June 2012

During a routine inspection

A compliance inspector and pharmacy inspector visited the provider over the course of an afternoon on the 20th June 2012. We spoke with the registered manager and with other staff. We also spoke with three people who use the service and looked at the personal files of six people. We also looked at a range of other records relating to the running of the service including staff personnel files and clinical audits.

People who use the service told us that 'Staff are very helpful', 'Staff are very supportive ' you can tell them anything' and commented that the practice was 'very organised'. They also told us that they were given suitable information about their proposed treatment. People commented that they were able to make informed decisions about their treatment and give their informed consent. We found that people's treatment options along with the potential benefits and side effects had been discussed with them. We also found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We found that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

People who use the service commented that they received their prescription in good time to enable them to access their prescribed medication. We found that medicines were prescribed and given to people appropriately and that people were cared for by suitably qualified, experienced staff.

25 October 2011

During an inspection looking at part of the service

During this inspection we focused on looking at how the provider had addressed improvement and compliance actions made at an earlier inspection in June 2011.

The provider was implementing a new file system for people who use the service. The provider obtained proof of identity for people using the service, and evidence of their ability to pay. Each person using the service was assessed when they joined. The provider made an entry into the person's file each time they were seen, but there were no care plans or evidence of these being reviewed. It was not always clear when a potential risk had been identified that this was appropriately followed up.

A new system to ensure everyone using the service is regularly urine tested was being developed. The provider had developed links with the GP's and pharmacies. People who use the service were protected from abuse.

We found that the provider needed to address issues around stocktaking and storing medication on the premises, and to liaise with the persons GP where medication for other health issues was being prescribed.

People who use the service benefit from safe premises and equipment. Appropriate recruitment checks had been carried out on staff. Some staff had completed relevant training since the last inspection, however regular supervision was not provided to all staff.

The provider had yet to develop systems that monitor outcomes for people using the service and clinically audit the medicines prescribed.

31 May 2011

During a routine inspection

The people who we spoke to were very positive in their feedback relating to staff and the service provided. We also looked at annual feedback forms that people using the service had completed and again found that people spoke with high regard for the staff and service provided.

However, our discussions with staff and the examination of a range of records found that the provider is non compliant in several area's. We found that some people using the service did not have care plans or risk assessments. We also found that the service had not developed appropriate links with GP's and pharmacies involved in the care of people using the service. The service had not developed appropriate safeguarding protocols, or links with local safeguarding agencies. Fire alarm testing at the premises was not recorded, and there was no evidence of maintenance to equipment used within the service.

We also found that the agency did not carry out appropriate pre employment checks on staff, or support them in accessing regular training and supervision opportunities to update their practise and monitor performance. The service has not developed appropriate quality assurance procedures. Some records had not been maintained by the service, and in personal files there was a lack of consistency in the way information was recorded.