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Waters Green Dental and Implant Clinic

Inspection Summary


Overall summary & rating

Updated 22 March 2017

We carried out an announced comprehensive inspection on 4 January 2017 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

Waters Green Dental and Implant Clinic is located close to the centre of Macclesfield and comprises a reception and waiting room, and a treatment room all at ground floor level. Parking is available on nearby streets and in car parks. The practice is accessible to patients with disabilities, limited mobility, and to wheelchair users. The provider has been providing a dental service at this location since 2013.

The practice provides general dental treatment to patients on a privately funded basis. The practice is open Monday and Friday 9.00am to 5.00pm, Tuesday 11.00am to 8.00pm, Wednesday 9.00am to 7.00pm, Thursday 9.00am to 8.00pm and Friday 9.00am to 5.00pm. The practice is staffed by a principal dentist, a dental hygienist/therapist and two dental nurse / receptionists.

The principal dentist is registered with the Care Quality Commission as an individual. 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 received feedback from five people during the inspection about the services provided. Patients commented that they found the practice excellent and that staff were professional, helpful and responsive. Patients commented that the practice was clean and comfortable.

Our key findings were:

  • There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
  • Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available.
  • The premises and equipment were clean and secure.
  • Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, standards, and guidance.
  • Patients received information about their care, proposed treatment, costs, benefits, and risks and were involved in making decisions about it.
  • Patients were treated with kindness, dignity, and respect, and their confidentiality was maintained.
  • The appointment system met the needs of patients, and emergency appointments were available.
  • Reasonable adjustments were made to enable patients to receive their care and treatment.
  • Staff were supervised, felt involved, and worked as a team.
  • Governance arrangements were in place for the running of the practice but were not all operating effectively.
  • The practice did not have a procedure in place to record and analyse significant events and incidents.
  • Staff were aware of the processes to follow to raise concerns, but had not received safeguarding training.
  • Staff followed current infection control guidelines for decontaminating and sterilising instruments but sterilisation equipment was not always checked for proper functioning.
  • Staff were supported to deliver effective care, and opportunities for training and learning were available but the provider did not monitor this to ensure essential training had been completed.

We identified regulations that were not being met and the provider must:

  • Ensure arrangements are implemented to receive and respond to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency and through the Central Alerting System, as well as from other relevant bodies such as, Public Health England.
  • Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
  • Ensure the practice’s infection control procedures and protocols are suitable having 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 waste is segregated and disposed of in accordance with relevant regulations and having due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01), specifically in relation to gypsum and local anaesthetic cartridges.
  • Ensure that the practice is in compliance with its legal obligations under the Ionising Radiations Regulations 1999 and Ionising Radiation (Medical Exposure) Regulations 2000.
  • Ensure the quality and safety of the service is assessed and monitored, for example, by carrying out regular audits of various aspects of the service, such as radiography and infection control. The provider should also ensure that audits have documented learning points, where relevant, and resulting improvements can be demonstrated.
  • Ensure an effective system is implemented for the recording, investigating and reviewing significant events and complaints with a view to preventing further occurrences and ensuring that improvements are made as a result.
  • Ensure staff are up to date with their training and their continuing professional development to support dental professionals in meeting the requirements of their regulator, the General Dental Council.
  • Ensure robust procedures to protect people are implemented and ensure all staff are trained in safeguarding children and vulnerable adults to an appropriate level for their role and aware of their responsibilities.
  • Ensure recruitment procedures are operated effectively in accordance with Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and ensure employment checks are carried out for all staff and the required specified information in respect of persons employed by the practice is available.

There were areas where the provider could make improvements and should:

  • Review the storage of dental care records to ensure all components are stored securely.
  • Review the practice’s complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.
  • Introduce a system to seek the views of stakeholders about all aspects of service delivery.
Inspection areas

Safe

No action required

Updated 22 March 2017

We found that this practice was providing safe care in accordance with the relevant regulations.

The premises was spacious, secure and properly maintained. The practice was cleaned regularly and there was a cleaning schedule in place identifying tasks to be completed.

The practice had emergency medicines and equipment available, including an automated external defibrillator. Staff were trained in responding to medical emergencies.

We saw that staff were registered with their professional body, the General Dental Council, and had indemnity insurance in place. Disclosure and Barring checks had been carried out for all staff.

Staff told us they were aware of the need to be open, honest and apologetic to patients if anything was to go wrong; this is in accordance with the Duty of Candour principle.

The provider did not have procedures in place to report and learn from significant events, incidents and accidents.

Staff were aware of how to identify and follow up on abuse but they had not received formal training in relation to safeguarding.

Staff were largely following current guidance for the decontamination and sterilisation of instruments but there were no documented procedures for staff to follow to assist them in the performance of these tasks. No method was in place to ensure the sterilising equipment was continuously functioning correctly.

Most equipment used in the practice, including medical emergency equipment had been appropriately tested and maintained but the X ray machine had not been tested within the recommended period.

Effective

No action required

Updated 22 March 2017

We found that this practice was providing effective care in accordance with the relevant regulations.

The practice followed current guidelines when delivering dental care and treatment to patients.

Patients’ medical history was recorded at their initial visit and updated at subsequent visits. The dentist carried out an assessment of the patient’s dental health. Patients were given a written treatment plan which detailed the treatments considered and agreed, together with the fees involved. Patients’ consent was obtained before treatment was provided; and treatment focused on the patients’ individual needs.

Staff provided oral health advice to patients and monitored changes in their oral health. Patients were referred to other services, where necessary, in a timely manner.

Qualified staff were registered with their professional body, the General Dental Council. Staff received some training to assist them in carrying out their roles but no monitoring was in place to ensure staff were meeting the requirements of their professional regulator.

Caring

No action required

Updated 22 March 2017

We found that this practice was providing caring services in accordance with the relevant regulations.

Patients commented that staff were caring and friendly. They told us they were treated with respect, and that they were happy with the care and treatment given.

Staff understood the importance of emotional support when delivering care to patients who were nervous of dental treatment. Patient feedback on CQC comment cards confirmed that staff were understanding and made them feel at ease.

The practice had separate rooms available if patients wished to speak in private.

We found that treatment was clearly explained, and patients were given time to decide before treatment was commenced. Patients commented that information given to them about options for treatment was helpful.

Responsive

No action required

Updated 22 March 2017

We found that this practice was providing responsive care in accordance with the relevant regulations.

Patients had access to appointments to suit their preferences, and emergency appointments were available on the same day. The practice opening hours and the ‘out of hours’ appointment information was provided at the entrance to the practice, in the practice leaflet, and on the practice website.

The practice captured social and lifestyle information on the medical history forms completed by patients which helped the dentists to identify patients’ specific needs and direct treatment to ensure the best outcome was achieved for the patient.

The provider had designed and furnished the premises to take into account the needs of different groups of people, for example, people with disabilities and people whose first language was not English. Staff were prompted to be aware of patients’ specific needs or medical conditions via the use of a flagging system on the dental care records.

The practice had a complaints policy in place however it was not made readily available to patients. Complaints were investigated and responded to in line with the policy.

Well-led

No action required

Updated 29 November 2017

We found that this practice was providing well-led care in accordance with the relevant regulations.

After the follow-up inspection on 8 August 2017 the practice provided an action plan explaining the arrangements the practice was putting in place to comply with the regulations.

We reviewed the provider’s systems for monitoring and improving the quality and safety of the service. We found that most policies and procedures were now customised to the practice’s circumstances and scheduled for review. The practice had introduced robust procedures for reporting and learning from significant events and accidents. We saw that these were working well.

We found that the practice had assessed most risks associated with dental practices and had improved the measures they had in place to reduce these risks.

We found that improvements had been made to the staff recruitment processes.

There was a management structure in place and staff felt supported. We saw evidence of regular communication between the principal dentist and trainee practice manager to ensure good governance and leadership were sustained in the long term.