We carried out this announced comprehensive inspection on 23 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
These questions form the framework for the areas we look at during the inspection.
Our findings were:
Are services safe?
We found that this practice was not providing safe care in accordance with the relevant regulations.
Are services effective?
We found that this practice was not providing effective care in accordance with the relevant regulations.
Are services caring?
We found that this practice was providing caring services in accordance with the relevant regulations.
Are services responsive?
We found that this practice was providing responsive care in accordance with the relevant regulations.
Are services well-led?
We found that this practice was not providing well-led care in accordance with the relevant regulations.
Background
Dr Parkash Photay – Midfield Parade is in Bexleyheath, in the London borough of Bexley. It provides private treatment to patients of all ages.
There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.
The dental team includes a dentist, three trainee dental nurses, and a receptionist/trainee dental nurse. The practice has one treatment room. The provider informed us a second dentist occasionally treated patients at the practice on a locum basis, and a third dentist (the principal dentist) occasionally attended the practice to perform dental treatments.
The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.
On the day of inspection we collected two CQC comment cards filled in by patients. This information gave us a positive view of the practice.
During the inspection we spoke with the dentist and receptionist/trainee dental nurse. We looked at practice policies and procedures and other records about how the service is managed, and we observed practice.
The practice is open from 9am to 6pm on Mondays, Tuesdays, Thursdays and Fridays, and from 9am to 8pm on Wednesdays. The dentist works at the practice on Mondays and Wednesdays; on Tuesdays Thursdays and Fridays the receptionist is available.
Our key findings were:
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The practice was clean.
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Staff took care to protect patients’ privacy and personal information.
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The appointment system met patients’ needs.
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The practice had not established thorough staff recruitment procedures.
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The practice was not able to demonstrate that all staff had received key training.
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Improvements were needed to ensure dental care records were maintained in line with current guidelines.
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The practice had safeguarding processes, though improvements could be made to ensure staff knew whom to report concerns to externally, and policies needed to be updated with key information.
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Appropriate medicines were available, though some life-saving equipment as per current recommendations was not available.
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The practice had some systems to help them manage risk, though improvements were needed to ensure these were dated, comprehensive and regularly reviewed.
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The practice had infection control procedures in place, though improvements were needed to ensure they reflected published guidance.
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The practice had not maintained several records pertaining to the running of the service and staff employed at the practice.
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Governance and leadership at the practice required improvements across several areas.
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Some staff did not feel supported.
Shortly after the inspection the provider took steps to begin to address our concerns.
We identified regulations the provider was not meeting. They must:
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Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
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Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
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Ensure specified information is available regarding each person employed.
Full details of the regulations the provider was not meeting are at the end of this report.
There are areas where the provider could make improvements. They should:
- Review the practice's waste handling protocols to ensure waste is segregated and disposed of in accordance with relevant regulations taking into account guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
- Review the protocols and procedures for use of X-ray equipment, taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.