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Archived: Skintek Dental, Laser & Aesthetic Clinic

The provider of this service changed - see new profile

We are carrying out a review of quality at Skintek Dental, Laser & Aesthetic Clinic. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 18 October 2018

During a routine inspection

We carried out this unannounced inspection on 18 October 2018 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 not 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

Skintek Dental, Laser and Aesthetic Clinic is in Crawley, West Sussex and provides private treatment to adults.

There is step free access for people who use wheelchairs and those with pushchairs. Car parking spaces for blue badge holders are available near the practice which is within a short walk of car parks.

The dental team includes the principal dentist, one associate dentist, one dental hygienist one dental nurse and two part-time receptionists. The practice has three 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.

During the inspection we spoke with two dentists, one dental hygienist, one dental nurse and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

  • Tuesday, Thursday and Friday 9.30am to 7pm
  • Wednesday 9.30am to 6pm
  • Saturday 9am to 5pm

Our key findings were:

  • The clinical staff provided patients’ care and treatment based on patients’ needs.
  • Staff took care to protect patients’ privacy and personal information. Improvements were required to the storage of patients’ dental care records.
  • The practice was providing preventive care and supporting patients to ensure better oral health.
  • The practice premises were clean and had recently undergone a total refurbishment.
  • The practice had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. All life-saving equipment and most medicines were available as described in recognised guidance.
  • The practice had limited systems to help them manage risk. Governance arrangements were poor and ineffective.
  • The practice had limited safeguarding processes and not all staff knew their responsibilities for safeguarding vulnerable adults and children.
  • The practice staff recruitment procedures required improving.
  • The appointment system met patients’ needs.
  • The practice lacked effective leadership and there were limited systems in place to encourage continuous improvement.
  • The practice asked staff and patients for feedback about the services they provided.
  • The practice had systems to deal with patient complaints positively and effectively.
  • Improvements were required to the information governance arrangements.

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

  • Ensure patients are protected from abuse and improper treatment
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Ensure specified information is available regarding each person employed.

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

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

  • Review 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. Ensuring that local rules reflect the equipment in the practice, radiation warning signs are in place and recording in patient’s dental care records the reason for taking X-rays and a report on the findings and quality of the image.
  • Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010. Ensuring that a disability access audit is complete.

Inspection carried out on 31 May 2017

During an inspection to make sure that the improvements required had been made

We carried out an announced follow-up inspection at Skintek Dental, Laser and Aesthetic Clinic on the 31 May 2017. This followed an announced comprehensive inspection on the 19 January 2017 carried out as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what actions they would take to meet the legal requirements in relation to the breaches.

We revisited Skintek Dental, Laser and Aesthetic Clinic and checked whether they had followed their action plan.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well-led? This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Skintek Dental, Laser and Aesthetic Clinic on our website at www.cqc.org.uk.

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow-up inspection was led by a CQC inspector who had access to remote advice from a specialist dental advisor.

During our inspection visit, we checked that points described in the provider’s action plan had been implemented by looking at a range of documents such as risk assessments, staff files, policies and staff training.

Our key findings were:

  • Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.

  • The practice had infection control procedures which reflected published guidance. There were systems in place to ensure that all equipment used to sterilise instruments was being validated as per national guidelines; and maintained as per manufacturer’s recommendations.
  • The practice had systems to help them manage risk.
  • The practice had staff recruitment procedures and all staff were meeting the requirements of their professional registration.
  • There was effective leadership at the practice and systems were in place to share information and learning amongst the team.
  • The practice had systems in place to seek feedback from patients who were complimentary about the service they received.

Inspection carried out on 19 January 2017

During a routine inspection

We carried out an announced comprehensive inspection on 19 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 not 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

Skintek Dental, Laser and Aesthetic Clinic is a general dental practice in Crawley, West Sussex offering private dental treatments to adult and children.

The practice has one dental treatment room, a decontamination room for the cleaning, sterilising and packing of dental instruments and a waiting/reception area. The practice is located on the first floor of the building and does not have full disabled access due to the stairs. A patient toilet is located on the second floor of the building.

The practice employs a principal dentist, a dental nurse who performs a dual role covering reception when required and one receptionist. The practice is open on Tuesdays to Thursdays from 9.30am to 8pm, Fridays from 9.30am to 4.30pm and Saturdays from 9am to 4.30pm. Out of hours is provided by the principal dentist.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

We reviewed 10 completed Care Quality Commission (CQC) comment cards on the day of the inspection. Patients commented on the kind and helpful staff. Patients told us that they were treated with respect and that the treatment is gentle and professional.

Our key findings were:

  • Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
  • We found the dentist regularly assessed each patient’s gum health and took X-rays at appropriate intervals.
  • Patients were involved in their care and treatment planning so they could make informed decisions.
  • Patients indicated that they found the team to be kind, professional and caring.
  • Patients were treated with dignity and respect and confidentiality was maintained.
  • The practice had some processes in place for safeguarding adults and children living in vulnerable circumstances although not all staff had received safeguarding training.
  • Governance arrangements were in place for the smooth running of the practice.
  • We found that some of the recommendations to improve the practice since our previous inspection in January 2016 had not been made.
  • Infection control procedures at the practice were not in line with national guidelines.
  • Not all necessary tests for effectiveness of the steriliser and compressor were being carried out.
  • The practice was not carrying out necessary employment checks in line with schedule 3 of the Health and Social Care Act 2008.

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

  • Ensure staff training and availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
  • Introduce systems to ensure that medical emergency equipment and medicines are checked at regular intervals.
  • Ensure that the risks to the health and safety of patients in relation to the prevention and control of infection are assessed and all that is reasonably practicable to mitigate any identified risks has been done.

  • Ensure systems are in place to assess, monitor and improve the quality of the service such as by undertaking regular infection control audits and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
  • Ensure that the risks to the health and safety of patients in relation to the prevention and control of legionella are assessed and all that is reasonably practicable to mitigate any identified risks has been done.
  • 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 that there is an effective system in place to monitor and review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.

You can see full details of the regulations not being met at the end of this report.

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

  • Review the training requirements of staff and consider arranging Mental Capacity Act 2005 training for relevant members of staff.

Inspection carried out on 12 January 2016

During a routine inspection

We carried out an announced comprehensive inspection on 12 January 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

We inspected dental services only at the practice.

Our findings were:

Are services safe?

We found that this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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.

Skintek Dental, Laser and Aesthetic Clinic is a general dental practice in Crawley, West Sussex, offering private dental treatment to adults and children.

The practice is situated in the centre of Crawley. The practice has one dental treatment room, a decontamination room for the cleaning, sterilising and packing of dental instruments and a waiting/reception area. The practice is located on the first floor of the building. The practice does not have full disabled access due to the stairs. The patient toilet is located on the second floor of the building.

The practice is open on Tuesdays, Thursdays and Fridays 10.00am to 5.30pm and alternate Saturdays between 10.00am and 4.00pm.

Skintek Dental, Laser and Aesthetic Clinic has one dentist (who is also the registered manager), two dental nurses (one of whom is a trainee) and one receptionist. The 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.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice. We collected 15 completed cards. All of the comments cards provided a positive view of the service the practice provides. Patients commented that staff were friendly, professional and understanding. Patients wrote that they were treated with respect and care. Two patients commented that the practice was clean and hygienic.

Our key findings were:

  • Patients were satisfied with the treatment and care they received and were complimentary about staff at the practice.
  • There were some systems in place to reduce the risk and spread of infection. However, the practice had not carried out a Legionella risk assessment or an Infection Prevention Society (IPS) self-assessment decontamination audit to assess compliance with regulations.
  • There were systems in place to check equipment had been serviced regularly, including the steriliser, fire extinguishers and the X-ray equipment. However, we found that electrical items had not been tested for electrical safety.
  • The practice did not have effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors in relation to fire safety, COSHH and Legionella.
  • The practice did not have a robust system in place to capture and analyse the comments and views of people who used the service.
  • Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).
  • We found that dental care records did not include a full description of examinations and patient discussions. Patient X-rays had not been justified or quality checked.
  • We observed that staff showed a caring and attentive approach towards patients. All patients were recognised and greeted warmly on arrival at reception.
  • The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children.

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

  • Ensure accurate, complete and contemporaneous records of the care and treatment provided to patients at the practice. This includes reviewing the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
  • Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000 by having local rules available to ensure the safe operation of X-ray equipment.
  • Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors in relation to fire safety, COSHH and Legionella.
  • Ensure an infection prevention and control self-assessment audit is carried out at regular intervals in order to assess compliance with HTM01-05.

You can see full details of the regulations not being met at the end of this report.

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

  • Implementing a robust system of collecting and analysing patient feedback in order to take patient’s comments and views into account.
  • Implementing the use of a log to record the monthly checking of emergency medicines and equipment.
  • Maintaining a system of regular formal staff meetings including the recording of staff meeting minutes to ensure any learning points are documented and monitored.
  • Carrying out electrical safety tests (PAT testing) on all relevant equipment in the practice.
  • Establishing an effective process for the on-going appraisal and supervision of all staff and review at appropriate intervals the training, learning and development needs of individual staff members.
  • Arranging Mental Capacity Act 2005 training for relevant members of staff.