Archived: Woodborough Dental Practice

Due to the eight-week suspension period we were unable at this inspection to assess interactions with patients and clinical activity due to the suspension of service provision.

At this inspection we were accompanied by a specialist dental adviser. The practice had made good progress to address the concerns raised at the last inspection and had implemented most of the action plan supplied by the provider. The evidence gathered during this inspection demonstrated staff had a greater understanding of the principles and practices required to meet the regulations for the safety and well-being of patients.

The evidence gathered during this inspection demonstrated action had been taken to address the risks of unsafe care and treatment at this practice. In the preceding four weeks the practice had undertaken further training in key areas identified at the last inspection and were able to fully demonstrate an understanding of the training and its application in practice.

We saw the environmental risks and hazards had been addressed. However there remained an outstanding environmental risk of Legionella from the water systems.

We were told and saw the provider had taken steps to assess and monitor the quality of service provided. We saw all three dentists had undertaken audits of various aspects of their care, treatment and service provision to meet the regulations. We saw the provider and practice had implemented systems and processes to regularly assess and monitor the quality of the service provided for the safety of patients.

We observed the decontamination practices had been reviewed and amended and now met the minimum requirements as set out in the Department of Health-Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM 01-05). The specialist dental adviser noted these improvements which had been made since the last inspection and judged them to be in line with the minimum required standards to minimise risk of cross infection.

We saw the provider had taken appropriate action to safely manage medicines. We saw medicines used for dental treatment and dental materials were appropriately stored and staff had a good understanding of the safe management of medicines.

We spoke with all six members of staff to obtain information about actions during this period of suspension of service. All staff told us they had worked hard to address the issues of concern identified at the last inspection. Two members of staff told us they felt the practice staff had increased their knowledge and understanding of the principles and practices required in law to provide good dental services.

During the time of suspension staff had worked to address the environmental issues and revisited training in key areas for safe practice. For example; training related to the safeguarding and protection of children and vulnerable adults; and infection prevention, control and decontamination of instruments and the practice for the safety, protection and well-being of patients.

At the last inspection and during this inspection the specialist dental adviser discussed with the provider his role in managing and running the practice. He identified with the provider areas of concern regarding the provider's fitness as a registered person due to his apparent lack of understanding in relation to his role and responsibilities particularly with regard to risk assessment, referral protocols and implementing actions to ensure compliance with the regulations for the safety and well-being of patients.

At this inspection we were accompanied by a specialist dental adviser. We found the practice had made progress to address the issues of concern identified and implement most of the action plan supplied by the provider. However the evidence gathered during this inspection demonstrated that while a lot of work had been done to meet the regulations there were still areas that required significant improvement. The specialist dental adviser told the provider these needed to be in place in order for the practice to be safe for the treatment of patients.

The evidence gathered during this inspection indicated patients were potentially at risk of unsafe care and treatment at this practice. The practice had undertaken some training in key areas identified at the last inspection. However staff were unable to fully demonstrate an understanding of the training and its application in practice for the safety of patients.

We saw some of the environmental risks and hazards had been addressed. However there remained some environmental risks due to incomplete renovations in the dental surgeries.

We were told and shown the provider had taken some steps to assess and monitor the quality of the service provided. However he had not implemented robust and effective operating systems to ensure the quality of service delivered was appropriately monitored and met with the regulations. The specialist dental adviser confirmed that without these systems and processes the provider would be unable to regularly assess and monitor the quality of the service provided for the safety of patients.

We observed the decontamination practices did not meet the requirements as set out in the Department of Health's - Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05). The specialist dental adviser noted the improvements which had been made since the last inspection. However he deemed the decontamination processes were not satisfactory to minimise risk of cross infection.

We saw the provider had taken some steps to manage medicines safely however not all appropriate actions had been taken. Staff spoken with demonstrated a lack of understanding of the requirements to safely manage medicines.

On the day of our visit there were no patients available to speak with as the service was suspended. However we received two complaints from patients who attended the practice.

We spoke with all eight members of staff to obtain information about actions during the period of suspension of services. All staff told us they had worked hard to address the issues of concern identified at the last inspection. One member of staff told us "it's given us the shake-up we needed". Another member of staff told us "it has brought us together as a team".

During the time of the suspension staff had received training in some key areas for safe practice. For example managing medical emergencies and safeguarding for the protection of children and vulnerable adults. Some members of staff demonstrated a good understanding of the recent training in medical emergencies. In respect of the safeguarding training key members of staff still lacked a full and appropriate understanding of their role and responsibilities for the safety, protection and well-being of patients.

The evidence gathered during this inspection indicated patients were at risk of unsafe care and treatment at this practice. This was because the provider had not taken proper steps to ensure patients were protected against the risks of receiving inappropriate or unsafe care and treatment. The provider had not ensured staff were appropriately supported. They had not maintained their skills and knowledge to a satisfactory standard to deliver care and treatment safely and to an appropriate standard.

The information received demonstrated patients may be at risk of inappropriate or unsafe care due to a lack of effective operating systems to regularly assess and monitor the quality of the service provided. We saw the provider did not manage medicines safely and had no risk assessments in place to ensure patients' safety when they attended the practice.

On the day of our visit we spoke with five patients who were complimentary about the practice. All felt they were treated with respect and dignity and they received a good service. All five patients told us treatment was explained however they were not provided with written treatment plans and costs prior to the commencement of treatment. They were not aware treatment options had been offered.

One patient told us "I've been coming here for 22 years and no complaints". Another patient told us "yes ' I'm satisfied with the treatment'.

Patients told us they could make an appointment at times that suited them. They told us they were aware of the emergency number and had always been able to get an appointment within 24 hours.

We observed the decontamination practices did not meet the requirements as set out in the Department of Health's - Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05).

The practice had access for patients with mobility issues and wheelchair users through the front of the building. Once in the practice there were facilities on the ground floor to provide all the services offered by the practice.

Arrangements were in place for managing medical emergencies. Staff were trained and medications and oxygen were available if required. Staff were aware of their responsibilities to safeguard children and vulnerable adults. There was a policy and other reference materials in place to support them in this.

There were processes in place for infection control and the decontamination of dental instruments, however, these were not fully compliant with current guidance. We also found that the systems in place for monitoring quality and safety were not effective in identifying issues with the running of the practice. People's confidentiality and privacy were not fully protected because patient records were stored in the waiting area of the practice, in a filing cabinet that was not locked.