Lower Brook Dental Surgery

We carried out this announced comprehensive inspection on 6 October 2022 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 practice 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:

• The dental clinic was visibly clean and well-maintained.
• The practice infection control procedures did not reflect published guidance.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available. However, regular checks were not undertaken in line with guidance and these were not documented.
• The practice systems to help them manage risk to patients and staff were not robust or effective. Specifically, decontamination and legionella management.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had staff recruitment procedures which reflected current legislation.
• Patient dental care records did not comply with recommended guidance.
• Patients were treated with dignity and respect and staff took care to protect their privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The dental clinic had information governance arrangements.

Background

Lower Brook Dental Surgery is in Ipswich, Suffolk and provides private dental care and treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice is located in a listed building and has made reasonable adjustments to support patients with additional needs.

The dental team includes 3 dentists, 1 visiting dentist, 4 dental nurses including 1 trainee dental nurse, 1 dental hygienist, 1 receptionist, 1 support staff and 1 practice manager. The practice has 3 treatment rooms.

During the inspection we spoke with 1 dentist, 3 dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday from 9am to 5.30pm.

Friday from 9am to 5pm.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Implement protocols for conscious sedation, taking into account the guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015. In particular review the necessity of a second oxygen cylinder where appropriate for the practice's circumstances.
• Implement an effective system of checks of medical emergency equipment and medicines taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. In particular; ensure a Service Level Agreement is in place for in-coming referring patients for the Cone-beam computed tomography (CBCT) machine and ensure rectangular collimation is available for X-ray equipment in all 3 treatment rooms.