We carried out an announced comprehensive inspection on 8 November 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?
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
Wynyard dental is a family-run dental practice which provides private treatment to patients of all ages. The practice is situated in a central complex within Wynyard Village, Teesside. There are two spacious treatment rooms each with their own decontamination area for sterilising dental instruments, two waiting areas (one with a dedicated children’s’ area) and a reception. There are ample car parking spaces in front of the practice. Access for wheelchair users or pushchairs is possible via the step-free ground floor entrance.
The practice is open Monday to Friday 0900 -1730 and Saturday 0900-1300.
The dental team is comprised of two principal dentists, an associate dentist, two qualified dental nurses and two receptionists. The practice is currently recruiting a third qualified dental nurse.
The provider is registered with the Care Quality Commission (CQC) as a partnership. A condition of their registration states the regulated activity procedures are to be managed by an individual who is registered as a manager. The provider had not ensured a registered manager had been appointed. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. We spoke with one of the registered partners and the associate dentist to advise this must be completed as part of their registration contract; they were considering the associate dentist to be appointed.
We reviewed nine CQC comment cards on the day of our visit; patients were very positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.
Our key findings were:
- The practice was visibly clean and free from clutter.
- The practice had systems for recording incidents and accidents.
- Staff received annual medical emergency training.
- Dental professionals provided treatment in accordance with current professional guidelines.
- Patients could access urgent care when required.
- Complaints were dealt with in an efficient and positive manner.
- An Infection prevention and control policy was in place. We saw sterilisation procedures followed recommended guidance. We were advised the practice did not keep any documentation for the checks of the sterilisation equipment.
- The practice did not have an effective management structure to regularly review the needs of staff (including their training) practice protocols or policies.
- The practice policies were not specific to the practice, not dated nor reviewed.
- Dental nursing and reception staff had not undergone training in safeguarding adults and vulnerable children, mental capacity or information governance.
- Recruitment procedures were not consistent.
We identified regulations that were not being met and the provider must:
- Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
- Ensure the practice implements the required control measures specified by their Legionella risk assessment giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
- Ensure the practice facilities are fit for the purposes to which they are being used. This includes assessing the practice’s disability access and fire risk.
- Ensure audits of various aspects of the service, such as infection prevention and control and radiography are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
- Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
You can see full details of the regulation not being met at the end of this report.
There were areas where the provider could make improvements and should:
- Review the practice's policies to ensure they contain appropriate details, are practice specific, dated and reviewed at regular intervals.
- Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
- Review the practice responsibilities in regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 to ensure all documentation is present and up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
- Review the practice’s procedure for maintaining logs of all sterilisation equipment giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum
01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
- Review the necessity to re-register the practice with the Information Commissioner’s Office (ICO) at appropriate intervals.
- Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
- Review the practice’s safeguarding policy and ensure all staff have had training at an appropriate level, in the safeguarding of children and vulnerable adults.
- Review the practice’s procedures for undertaking patient and staff satisfaction surveys to help improve the quality of service.