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Reports


Inspection carried out on 6 December 2018

During a routine inspection

We undertook a follow up focused inspection of Photay and Associates - Long Lane. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Photay and Associates - Long Lane on

24 April 2018under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care in accordance with the relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Photay and Associates - Long Lane dental practice on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 24 April 2018.

Background

Photay and Associates - Long Lane is in Bexleyheath and provides NHS and private treatment to adults and children.

The dental team includes two dentists, a clinical dental technician, a qualified dental nurse, a trainee dental nurse, and a practice manager. The dental nurses also undertake receptionist duties. The practice has a treatment room on the ground floor of the premises.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at the practice was one of the partners.

The practice is open from 9am to 5pm Monday to Friday.

Our key findings were:

At the previous inspection we found this practice was providing safe care in accordance with the relevant regulations but told them there were things they should do. We found that the provider had taken action to address the issues we said they should look at. We found that:

•Clinical staff had adequate immunity for vaccine for preventable infectious diseases.

• The practice had protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.

• Staff were aware of their responsibilities in relation to the Control of Substances Hazardous to Health (COSHH), the Reporting of Incidents Diseases and Dangerous Occurrences (RIDDOR), safety alerts, safeguarding leads, the mental Capacity Act and consent for under 16s.

• The practice’s system for documentation of actions taken, and learning shared, in response to

incidents with a view to preventing further occurrences and ensuring improvements are made as a result.

At the previous inspection we found this practice was providing effective care in accordance with the relevant regulations but told them there were things they should do. We found that the provider had taken action to address the issues we said they should look at. We found that:

• Prescription pads were locked away securely in a locked safe.

• The practice had protocols in place for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• The practice had protocols for referral of patients to ensure all referrals are monitored suitably.

• The practice was generally clean and well maintained but some improvements were required. For example, in regard to the cleaning of walls and skirting in the decontamination room.

At the previous inspection we found this practice was providing responsive care in accordance with the relevant regulations but told them there were things they should do. We found that the provider had taken action to address the issues we said they should look at. We found that:

• Arrangements had been agreed by the practice to ensure the availability of interpreter services for patients who do not speak or understand English as a first language. This would be done by on line interpretation services.

• The practice had adequate staff recruitment procedures.

• The practice had effective leadership and culture of continuous improvement.

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

  • Review the practice’s systems in place for environmental cleaning taking into account current national guidelines.
  • Review its responsibilities to respond to meet the needs of patients with disability and the requirements of the Equality Act 2010.

Inspection carried out on 24 April 2018

During a routine inspection

We carried out this announced inspection on 24 April 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 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:

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

Photay and Associates – Long Lane is in Bexleyheath, in the London Borough of Bexley. The practice provides NHS and private treatment to patients of all ages.

There is no level access via a ramp for people who use wheelchairs and those with pushchairs. There is parking available in the surrounding streets.

The dental team includes two dentists, a clinical dental technician, a qualified dental nurse, a trainee dental nurse, and a practice manager. The dental nurses also undertake receptionist duties. The practice has a treatment room on the ground floor of the premises.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at the practice was one of the partners.

On the day of inspection we obtained feedback from four patients.

During the inspection we spoke with two dentists, the dental nurses, the registered manager and the practice manager. We checked practice policies and procedures and other records about how the service was managed.

The practice is open from 9am to 5pm Monday to Friday.

Our key findings were:

  • The practice appeared clean and well maintained in most areas.
  • Staff knew how to deal with emergencies.
  • 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 practice was providing preventive care and supporting patients to ensure better oral health.
  • The appointment system met patients’ needs.
  • Staff felt involved and supported.
  • The practice dealt with complaints positively and efficiently.
  • Medicines and life-saving equipment were available.
  • Recruitment checks such as employment histories, photographic identification and Disclosure and Barring Service checks were not in place.
  • Continuing professional development records were not available for some staff to show they had completed and updated key training.
  • Staff had not received appraisals.
  • There was a lack of effective systems and processes to ensure good governance.

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.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The provider assured us following our visit that they had begun to address these issues and put procedures in place to manage the risks. We will check these improvements have been implemented, sustained and embedded when we carry out a follow-up inspection of the practice.

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

  • Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
  • Review the practice’s systems in place for environmental cleaning taking into account current national guidelines, and the security of waste storage.
  • Review the practice’s system for documentation of actions taken, and learning shared, in response to incidents with a view to preventing further occurrences and ensuring improvements are made as a result.
  • Review the use of prescription pads in the practice to prevent misuse.
  • Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
  • Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
  • Review the availability of interpreter services for patients who do not speak or understand English as a first language.
  • Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
  • Review staff awareness of their responsibilities in relation to the Control of Substances Hazardous to Health (COSHH), the Reporting of Incidents Diseases and Dangerous Occurrences (RIDDOR), safety alerts, safeguarding leads, the mental Capacity Act and consent for under 16s.