We carried out this announced comprehensive inspection on 7 March 2023 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 practice 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 advisor.
To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:
- The dental clinic appeared clean and well-maintained.
- The practice had infection control procedures which mostly reflected published guidance.
- Staff knew how to deal with medical emergencies. Appropriate medicines and most life-saving equipment were available. However, the oxygen cylinder had passed its use-by-date of in 2009, oropharyngeal airways and face masks were either not available on the day or out of date and the temperature of the fridge where the medicine used to manage low blood sugar was not monitored to ensure the medicine was effective.
- The practice had limited systems to help them manage risk to patients and staff. There were shortfalls in the assessment and mitigation of risk in relation to management of medical emergencies, fire, servicing of equipment, dental materials and the Control of Substances Hazardous to Health.
- Some safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children. However, not all staff were trained to a level appropriate for their role.
- The practice had staff recruitment procedures which mostly reflected current legislation as not all staff had a recent Disclosing and Barring Service (DBS) check or risk assessment at the point of employment.
- Clinical staff provided patients’ care and treatment in line with current guidelines.
- Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
- Staff provided preventive care and supported patients to ensure better oral health.
- The appointment system worked efficiently to respond to patients’ needs.
- The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
- Staff felt involved, supported and worked as a team.
- Staff and patients were asked for feedback about the services provided.
- The practice had not registered with the Information Commissioners Office (ICO) to process data.
Background
Dillwyn and Caroline Griffiths Dental Surgery is in Radlett, Hertfordshire and provides private dental care and treatment for adults and children.
There is step free access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the front of the practice. The practice has made reasonable adjustments to support patients with access requirements.
The dental team includes 2 principal dentists, 1 dental nurse and 1 receptionist. The practice has 2 treatment rooms.
During the inspection we spoke with all the members of staff. We looked at practice policies, procedures and other records to assess how the service is managed.
The practice is open:
Monday from 9am to 5pm
Tuesday from 8am to 12pm
Wednesday from 10.30am to 6pm
Thursday from 10am to 6pm
Friday from 7.30am to 11am
The practice had taken steps to improve environmental sustainability. For example, the practice had introduced the use of bamboo toothbrushes and charcoal floss.
We identified regulation the provider was not complying with. They must:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Full details of the regulation the provider was not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice and take action to ensure audits of infection prevention and control are undertaken in line with guidance to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
- Take action to implement any recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’ In particular, ensuring the risk assessment is undertaken by a competent person.
- Implement an effective recruitment procedure to ensure that appropriate checks are completed prior to new staff commencing employment at the practice. In particular that Disclosure and Barring service checks are undertaken at the point of employment and that risk assessments are completed where appropriate, for staff where immunity to Hepatitis B is low.