In response to concerns raised to the CQC we carried out this unannounced inspection on 5 September 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 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
Gnosall Dental Practice is in Gnosall and provides NHS and private treatment to patients of all ages.
There are steps to gain access to the building therefore level access is not available for people who use wheelchairs and pushchairs. Car parking spaces, including those for patients with disabled badges, are available at the rear of the practice in the shopping centre car park.
The dental team includes one dentist, three dental nurses, one dental hygienist, a secretary and a receptionist. The practice has two treatment rooms.
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 did not collect any CQC comment cards as this inspection was unannounced. We spoke with four patients during the inspection. This information gave us a positive view of the practice.
During the inspection we spoke with the principal dentist, one dental nurse, the receptionist and the company secretary. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday 9am to 5pm, Tuesday and Wednesday 8.30am to 5.30pm, Thursday 9am to 5.30pm and Friday 9am to 12pm.
Our key findings were:
- The practice was clean and well maintained.
- Infection control procedures did not all reflect published guidance. For example the practice used bleach to clean work surfaces in treatment rooms and were not disposing of and changing household gloves used in decontamination processes at the required frequency.
- Staff knew how to deal with emergencies but basic life support and emergency medical training was overdue. We were told that this training was booked for September 2017. Not all of the recommended emergency medicines and life-saving equipment was available but this was purchased following this inspection.
- The practice’s systems to help them manage risk were not robust. For example the practice had not completed a fire or sharps risk assessment. The practice were not completing an assessment of any premises they visited when they undertook domiciliary visits and had not assessed the individual circumstances to determine which emergency medicines and equipment may be required on these visits.
- The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The practice’s staff recruitment procedures did not ensure that all information as detailed in Schedule three of the Health and Social Care Act was available.
- 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.
- Staff at the practice told us that they felt involved and supported and worked well as a team.
- The practice asked patients for feedback about the services they provided.
- The practice’s complaints policies required updating to provide information to patients of the external bodies that patients are able to complain to if they are not satisfied with the outcome of the investigation completed at the practice.
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.
Full details of the regulations the provider was not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Review systems for the recording, investigating and reviewing accidents or significant events which would help to prevent further occurrences and, ensure that improvements are made as a result.
- Review the storage of dental care records to ensure they are stored securely.
- Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.
- Review its responsibilities as regards the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.
- Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
- Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.