We carried out an announced comprehensive inspection on 28 July 2015 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
Chadwell Health Dental Practice is based in the London borough of Redbridge in Essex, a suburban area of East London. It provides general dentistry, advanced dentistry including periodontal and orthodontic treatment and a sedation service. The practice treats children and adults. The practice was taken over by the current registered provider, a Partnership of two dentists, in December 2014.
Patients have a choice of NHS and private dental treatment. In terms of turnover, 65% of the treatment provided is NHS. Approximately one third of patients using the sedation service have been referred by other dentists in the local area and 90% of these receive NHS treatment. There is a waiting list of six to seven months for children requiring the sedation service, and two to three months for adults.
The practice is open from 9.00am to 6.00pm Monday to Friday, and from 9.00am to 4.00pm on Saturday. There are seven surgeries. Four of these together, with the recovery area make up the sedation service. There is a separate decontamination room.
Fifteen dentists and three sedationists work at the practice on a part-time basis as associates. Seven dental nurses including a recovery nurse, three trainee dental care practitioners, and three hygienists also work part time at the practice. There is a full time practice manager and two full time and two part time reception staff. The principal dentist is one of the two Partners.
The practice manager is the registered manager. 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.
Patients completed CQC comment cards in the two weeks prior to our inspection to tell us what they thought about the practice. We received 23 completed cards all of which were very positive about the service patients had experienced. Patients described treatment and care as being of a very high standard and said staff were caring, helpful, polite and considerate. Patients felt reassured and safe; that they had been listened to and put at ease; and that their treatment had been explained to them well.
We spoke with four patients during our visit. They too had nothing but praise for the service.
Our key findings were:
- Systems were in place so that the practice could learn from incidents, children and vulnerable adults were safeguarded from abuse, and the risk of the spread of infection was minimised.
- The practice was well equipped to carry out the wide range of dentistry on offer and medicines were well managed to ensure they were fit for use and were not misused.
- Employees and associate staff knew how to treat patients in a medical emergency and had the appropriate equipment and drugs available to them.
- Treatment was provided in line with recognised professional guidelines. Clinical staff had the necessary skills and qualifications.
- Patients rated the treatment and care they received very highly.
- The service was responsive to patients’ needs, for example through longer appointment times for some types of treatment, offering a choice of dentist, and providing accessible premises and interpreters where required. There was however a waiting list of several months for the sedation service.
- New governance arrangements introduced by the new provider were not embedded. Lines of accountability were unclear in some areas. Patient feedback was being collected but not acted on.
We identified regulations that were not being met however and the provider must:
- 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 risk assessments are completed for all hazardous substances in the practice and that effective precautions are in place to reduce exposure to hazardous substances to a minimum.
- Ensure adequate radiation protection arrangements are in place.
- Maintain records necessary to ensuring good governance and the safety and quality of the service.
- Ensure patient feedback is acted on to improve the service.
You can see full details of the regulations not being met at the end of this report.
There were areas also where the provider could make improvements and it should:
- Put in place a system to provide assurance that employees and associate staff have responded promptly to Medicines and Healthcare products Regulatory Agency (MHRA) advice.
- Review the way information from practice meetings is disseminated to employees and associates not able to attend, to ensure they receive information in a timely way.
- Put in place a system to provide assurance that archived records are stored appropriately.
- Respond to any staff concerns about the workplace identified in the employee appraisal process before waiting for the implementation of the employee appraisal process to be completed.