Updated 12 July 2017
We carried out this unannounced inspection on 1 and 2 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection in response to specific concerns about the practice, and 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 providing safe care in accordance with the relevant regulations.
Are services effective?
We found that this practice was 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
Old Street Dental Practice is in Old Street, in the London Borough of Islington. It provides NHS and private treatment to patients of all ages.
The practice is situated on the first floor of a purpose-built building, and there is no level access for people who use wheelchairs or those with pushchairs. There are limited paid car parking spaces in the surrounding streets.
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.
The dental team includes three general dentists, an implantologist, a receptionist, two dental hygienists, and three dental nurses.
During the inspection we spoke with all of the dentists and dental nurses, and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open from 8am to 6pm Monday to Friday.
Our key findings were:
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment system met patients’ needs.
- The practice asked patients for feedback about the services they provided.
- The practice had infection control procedures, though these did not always reflect published guidance.
- The practice had suitable safeguarding processes, though improvements were need to ensure all staff were had a good understanding of their responsibilities.
- Staff knew how to deal with emergencies. Appropriate medicines were available, though some life-saving equipment was absent.
- The practice was clean and well maintained in most areas, though some improvements were needed.
- The practice had not established thorough staff recruitment procedures.
- Staff felt involved and supported, and worked well as a team, though governance and leadership at the practice required improvements.
- The practice was not able to demonstrate that all staff had received key training.
- The practice had not maintained several records pertaining to the running of the service and staff employed.
Shortly after the inspection the provider took steps to begin to address several of the issues identified.
We identified regulations the provider was not meeting. They must:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- 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.
- 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.
Furthermore, there are areas where the provider could make improvements. They should:
- Review staff members’ understanding of their roles and responsibilities, particularly in relation to significant events and reporting safeguarding concerns to external organisations.
- Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
- 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.
- Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.