• Dentist
  • Dentist

Archived: Limes Dental Centre

2 Simpson Grove, Boothstown, Worsley, Manchester, Greater Manchester, M28 1LY (0161) 703 7773

Provided and run by:
Mrs. Deborah Cail

All Inspections

21 November 2019

During an inspection looking at part of the service

We carried out this unannounced inspection on 21 November 2019 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 second inspector.

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

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Limes Dental Centre is in Worsley, Manchester and provides NHS and private treatment for adults and children.

Portable ramps are available for people who use wheelchairs and those with pushchairs. On street parking is available near the practice.

The team is comprised of the practice owner and a part time dental therapist. There is a practice manager who provides oversight of the service and a receptionist. The practice currently employs the services of locum dentists and agency dental nurses to provide the service. There are two 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 the practice owner, one locum dentist, one agency dental nurse and an agency receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9am to 1pm and 2pm to 5.30pm

Tuesday 9am to 12.30pm

Wednesday and Thursday 9am to 1pm and 2pm to 6pm

Friday 9am to 1pm.

Our key findings were:

  • The practice appeared to be visibly clean and tidy. Some maintenance of the building and fixtures was required.
  • Infection control procedures require improvement.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. The pads for the automated external defibrillator had expired.
  • The provider had some systems to help them manage risk to patients and staff.
  • The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • The staff recruitment procedures did not reflect current legislation.
  • 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 provider had information governance arrangements.

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

  • Ensure care and treatment is provided in a safe way to patients.
  • 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.

Full details of the regulations the provider is not meeting are at the end of this report.

1 July 2019

During an inspection looking at part of the service

We undertook a follow up focused inspection of Limes Dental Centre on 1 July 2019. 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.

We undertook a comprehensive inspection of Limes Dental Centre on 8 November 2018

under 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 and was in breach of regulation 17 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 Limes Dental Centre on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

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 areas where improvement was required.

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 breach we found at our inspection on 8 November 2018.

Background

Limes Dental Centre is in Worsley, Manchester and provides NHS and private treatment for adults and children.

Portable ramps are available for people who use wheelchairs and those with pushchairs. On street parking is available near the practice.

The team is comprised of the practice owner who is also the dentist and a part time dental therapist. The owner’s partner provides management, business, administrative and reception support. There is one employed dental nurse/receptionist and the practice employs the services of agency dental nurses. There are two 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 the practice owner and their partner. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9am to 1pm and 2pm to 5.30pm

Tuesday 9am to 12.30pm

Wednesday and Thursday 9am to 1pm and 2pm to 6pm

Friday 9am to 1pm.

Our key findings were:

  • Emergency medicines and life-saving equipment were in line with guidance. We saw evidence of life support training.
  • The systems to help them identify and manage risks had been improved. In particular, radiography, incident reporting, the management of hazardous substances, prescription security and safety alerts.
  • The practice safeguarding processes had been updated and made available to staff.
  • The provider had thorough recruitment procedures in relation to employed and agency staff.
  • Systems were in place to ensure waste was segregated appropriately and gypsum waste disposed of in line with legislation.

8 November 2018

During a routine inspection

We carried out this announced inspection on 8 November 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 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

Limes Dental Centre is in Worsley, Manchester and provides NHS and private treatment for adults and children.

Portable ramps are available for people who use wheelchairs and those with pushchairs. On street parking is available near the practice.

The team is comprised of the practice owner who is also the dentist and a part time dental therapist. The owner’s partner provides management, business, administrative and reception support. At the time of the inspection, there were no dental nurses employed by the practice. They employ agency dental nurses. There are two 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.

On the day of inspection, we collected one CQC comment card filled in by patients and saw other sources of patient feedback.

During the inspection we spoke with the practice owner, their partner and an agency dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9am to 1pm and 2pm to 5.30pm

Tuesday 9am to 12.30pm

Wednesday and Thursday 9am to 1pm and 2pm to 6pm

Friday 9am to 1pm.

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider had infection control procedures which reflected published guidance.
  • Emergency medicines and life-saving equipment were not in line with guidance. Arrangements for life support training required improvement.
  • The systems to help them identify and manage risks to patients and staff required improvement.
  • The practice safeguarding processes required updating and making available to staff.
  • The provider did not have thorough recruitment procedures in relation to employed or agency staff.
  • 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 provider was providing preventive care and supporting patients to ensure better oral health.
  • The appointment system met patients’ needs.
  • The practice asked patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements.

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

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider is not meeting are at the end of this report.

18 October 2012

During a routine inspection

We visited Limes Dental Centre on 18 October 2012.

We observed that all areas were clean and that posters promoting oral hygiene and offering information about the practice were displayed within the reception area. We saw that policies and procedures were accessible to staff and emergency medical equipment was in place. Decontamination processes were seen to be followed and hygiene procedures were adhered to by staff to minimise the risk of cross infection.

We looked at a sample of five patients' records, which contained patients' medical information, treatment plans and personal preferences. There was evidence within the records that these were regularly reviewed and updated.

We spoke with three members of staff who were suitably qualified for their roles and had undertaken relevant training during their employment. We observed staff members interacting politely and with respect towards patients and noted that patients had their privacy and dignity respected during treatment.

We spoke with ten patients and all expressed satisfaction with their treatment, the politeness of the staff and the cleanliness of the environment. One patient told us that 'everything was explained in detail about what would be done.' Another patient said that the explanation of their treatment was given by 'paperwork and conversation.'

We observed that comments and complaints were taken seriously by the practice and used to inform changes and improvements to the service delivered.