The Care Quality Commission
  • Residential substance misuse service

Asana Lodge

Overall: Requires improvement read more about inspection ratings

48 Moorend Road, Yardley Gobion, Towcester, Northamptonshire, NN12 7UF (01908) 543251

Provided and run by:
ASANA Healthcare Ltd

All Inspections

10 October 2023

During an inspection looking at part of the service

Asana Lodge opened in June 2020 and is a 22 bedded residential drug and/or alcohol medically monitored, detoxification and rehabilitation facility based in Yardley Gobion, Towcester. The service provides care and treatment for male and female clients. Asana Lodge provides ongoing abstinence-based treatment, which is based on cognitive behavioural therapy and dialectical behaviour therapy alongside 12-step treatment.

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

• Staff did not have access to Naloxone (Naloxone is used to reverse the effects of opioids).

• The service did not have access to an emergency bag or emergency drugs, as outlined in the provider’s policy to meet client need.

• Staff did not always complete physical health checks of clients withdrawing from alcohol dependency at the frequency set out in the doctor’s instructions.

• The service was unable to evidence that clinical equipment had been replaced or calibrated within the last 6 months.

• The service continued to not always have immediate access to medical summaries from the patient’s GP.

• There was not enough permanent staff to meet the needs of the clients, however the service had covered vacancies with the use of agency staff. This led to high usage of bank and agency staff.

• Staff could not observe clients in all areas of the service.

• The service did not have robust systems and processes around the usage of CCTV. This included signage and audits of its usage.

• The current mandatory training rate for mental capacity was 62%, fire marshal training 52%, and medicines management (for the electronic health record) was 67%.

• Client’s care plans were not personalised, holistic or recovery oriented. Staff did not fully involve clients in care planning or gave clients copies of their care plans.

• Staff had not received supervision during the 8 weeks prior to our inspection.

• Managers had not ensured that all staff had received specialist training for their role.

• There was a lack of governance systems and processes within the unit.

However:

• The service adhered to health and safety requirements. Fire risk assessments and the health and safety folders were up to date. All maintenance requests had been actioned.

• All areas were clean, well maintained, well-furnished and fit for purpose.

• Staff checked, maintained, and cleaned equipment. Staff checked the defibrillator each week. The service had a range of appropriate rooms to meet clients.

• Clients received a comprehensive assessment in a timely manner which included a physical health assessment. All clients had received a face-to-face assessment.

• Staff were able to identify signs of deteriorating mental health.

• Risk management plans were discussed upon first assessment and regularly reviewed thereafter.

• Staff received training on how to recognise and report abuse, appropriate for their role.

• Staff completed a comprehensive mental health assessment of each client on admission.

• Staff were discreet, respectful, and responsive when caring for clients.

• Staff introduced clients to the service and the services as part of their admission.

• Clients could make their own hot drinks and snacks and were not dependent on staff

06 February 2023 - 14 February 2023

During a routine inspection

Asana Lodge opened in June 2020 and is a 22 bedded residential drug and/or alcohol medically monitored, detoxification and rehabilitation facility based in Yardley Gobion, Towcester. The service provides care and treatment for male and female clients

We rated it as ​inadequate​ because:

  • Staff did not make a comprehensive assessment of client’s physical and mental healthcare needs before treatment started. The prescriber did not conduct a face-to-face assessment of clients before issuing the first prescription and before making any changes to prescriptions.
  • The admissions assessment and process was not thorough and did not take into account clients medical history, medical conditions and prescribed medications. This led to inappropriate admissions and allergies not being recorded. The service did not have clients full medical history before starting treatment.
  • Medicine were not always managed safely and in line with legislation. Staff administered a prescription only medicines without an individualised prescription. The service did not complete reviews or log why clients were having regular homely remedies for multiple days.
  • Not all medicines were prescribed with a clear prescribing rationale or a clear discussion with the client around possible side effects.
  • Staff did not complete appropriate protocols for clients prescribed ‘as required’ medicines
  • Staff did not always complete post incident checks. Injuries sustained after an incident were not always recorded clearly and staff did not always complete and record thorough checks after an incident.
  • Staff had not completed comprehensive client risk assessments and risk management plans or updated them to reflect clients changing risks. Managers at the service did not have the knowledge and skills to be able to identify for themselves that the service was not keeping clients safe in terms of assessing and prescribing.
  • Governance processes in place did not identify areas where compliance with the requirements of the regulations was not being met. Auditing systems did not identify where staff were not following medication management and administration within legal parameters. Auditing systems did not identify gaps in post incident checks and logs.

However:

  • The service offered a range of therapies including yoga, walks, sound therapy and regular one to one sessions, with something available 7 days a week.
  • The clinical premises where clients were seen were safe and clean. The service had enough staff.
  • The service provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. The provider made training, supervision and appraisal opportunities available to staff. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff treated clients with compassion and kindness. Staff understood the individual needs of clients and supported them to understand and manage their treatment and condition.
  • The service offered a well-established, weekly family and carer group.
  • Staff felt respected, supported and valued. They felt positive about their work and proud about working for the provider and delivering the service.
  • Following the inspection and enforcement action taken the service told us they had implemented new auditing systems, governance processes and medication management policies and procedures.

Immediately following this inspection, we issued an urgent letter of intent to ask the provider to take immediate action to improve safety at this location. We did not receive immediate assurance that safety was addressed and so issued further urgent enforcement action to impose conditions on registration.

27 May 2021

During an inspection looking at part of the service

This was an unannounced focused inspection, undertaken due concerns about the quality of risk assessments, the safety of clients, the quality and outcome of investigations and the overall management of governance systems.

We did not look at all key lines of enquiry during this inspection. However, the information we gathered provided enough information to make a judgement about the quality of care. We have reported, but not rated on the following domains:

• Safe

• Effective

• Well Led

Asana Lodge was registered by the Care Quality Commission on 20 April 2020. New services are assessed to check they are likely to be safe, effective, caring, responsive and well-led. The Care Quality Commission has not carried out any previous inspections at Asana Lodge.

We did not rate this inspection. However, we found the following areas of concern:

  • The provider had not ensured staff were adequately trained to provide safe care and treatment to clients. Staff had not received adequate training, supervision, appraisal or induction. Staff were not trained in Mental Capacity Act and did not discuss or check capacity to consent to treatment with clients on admission.
  • Leaders did not have the skills, knowledge or experience to perform their roles, or have a good understanding of the service they managed. The provider did not have systems and processes in place to manage risks to both staff and clients. The provider did not complete regular audits of care provided to clients and had no way to monitor the effectiveness of the service. The provider did not effectively or robustly investigate poor staff performance. The provider had not reported incidents that were notifiable to the Care Quality Commission in a timely manner. Systems and processes for the management of complaints was not effective.
  • Ligature risk assessments were not being completed in line with the providers’ policy.
  • Staff did not adequately assess and manage client risk. Unexpected exit from treatment and crisis plans had not been completed. Staff did not work with clients to develop individual care plans.
  • The service did not have systems and processes to safely prescribe, administer, record and store medicines.
  • The service did not have processes in place to monitor the security of the information being sent to clients from staff members personal mobile phones.

However;

  • All premises where clients received care were clean, well equipped, well-furnished and well maintained.
  • Staff completed routine monitoring of clients’ physical healthcare and regular observations of clients. Staff had completed a comprehensive pre-admission and post admission assessments with all clients. Staff undertook a range of physical health assessments and completed exit questionnaires on discharge.
  • Staff felt respected, supported and valued. Staff felt positive and proud about working for the provider.

This inspection took place on the 27 May 2021. Following our inspection, because of the serious concerns we had about client’s safety, we served an urgent Notice of Decision. We told the provider they must not admit any new clients without the prior written agreement of the Care Quality Commission. We told the provider they must ensure that all incidents, past and present are reviewed and investigated and all notifications requiring submission to the Care Quality Commission are completed in full. We told the provider they must undertake a review of all clinical records, such as care plans and risk assessments for all clients, they must complete a review of all ligature risk assessments and complete an action plan to mitigate all risks identified. We told the provider they must carry out a review of staff qualifications and they must submit evidence of their application for a Home Office Stock license. We also told the provider they must undertake a review of all governance systems and processes at Asana Lodge and devise appropriate policies.