Archived: Hornchurch Family Dental Practice

Updated 10 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. 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.

This announced inspection was carried out on 27 January 2016 by an inspector from the Care Quality Commission (CQC) and a dental specialist advisor.

During the inspection we viewed the premises, spoke with the dentist, dental nurse, and receptionist. To assess the quality of care provided we looked at practice policies and protocols and other records relating to the management of the service.

We also reviewed information we had asked the provider to send us in advance of the inspection. This included their latest statement of purpose describing their values and objectives.

We received feedback from twenty six patients. All patients commented positively about dentists, dental nurses and reception staff. They described staff as caring and friendly.

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 therefore formed the framework for the areas we looked at during the inspection.

Prior to the inspection we reviewed information we held about the provider.

Updated 10 March 2016

We carried out an announced comprehensive inspection on 27 January 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 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

Hornchurch Dental Practice provides NHS and private dental treatment to patients of all ages. The services provided include preventative advice and treatment and routine restorative dental care. The practice staffing consists of a dentist who is also the registered manager, one associate dentist, and two dental nurses/receptionists.

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.

The practice consists of two treatment rooms, a waiting area for patients and reception area, a staff room, decontamination room and X-ray room

The practice opening hours are Monday to Thursday 9.30am to 5pm and Friday 9am to 5pm

Twenty-six patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received and about the service. Patients told us that they were happy with the dental treatment and advice they had received.

Our key findings were:

• Patients’ care and treatment was planned and delivered in line with current legislation and evidence based guidelines such as from the National Institute for Health and Care Excellence (NICE).
• Staff had received safeguarding children and vulnerable adults training and were aware of the processes to follow to raise any safeguarding concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect and patient confidentiality was maintained.
• The practice had a procedure for handling and responding to complaints. The practice’s complaints policy was displayed in the waiting area and was available to patients.
• There were systems in place to ensure that equipment including the suction apparatus, compressor unit, autoclave and fire extinguishers had been serviced regularly.
• The practice had no arrangements for receiving and responding to patient safety alerts issued from relevant external agencies.
• Staff had undertaken training in key areas such as infection control and radiography; however there was lack of oversight of staff’s continuing professional development (CPD) activity and it was not being suitably monitored.
• The practice had not ensured that appropriate equipment, medical oxygen and all medicines in line with British National Formulary and Resuscitation Council (UK) guidance were available to respond to a medical emergency.
• Infection control protocols were not being followed in line with recommended national guidance.
• The practice had not undertaken a risk assessment in relation to the Control of Substances Hazardous to Health 2002 (COSHH) regulations.
• Governance systems were not effective. There were a range of policies and procedures in place; however staff had little understanding of the policies with little adaptation to the practice.
• Dental care records were not being suitably completed in line with guidance provided by the Faculty of General Dental Practice.
• The practice had routinely carried out audits in key areas, such as radiography and infection prevention and control (IPC); however audits were not effective in identifying short comings at the practice.

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

• Ensure the practice’s infection control procedures and protocols are suitable 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 availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure systems in place to assess, monitor and improve the quality of the service are effective and where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

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:

• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• 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 staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.