Archived: D B Allen - Rawtenstall

We undertook a follow up focused inspection of D B Allen - Rawtenstall on 8 November 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of D B Allen - Rawtenstall on 23 April 2019 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 safe or well led care and was in breach of regulations 12 and 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

D B Allen - Rawtentstall on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• 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 safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 23 April 2019.

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 23 April 2019.

Background

D B Allen Rawtenstall is in Rossendale, Lancashire and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. There is no car parking immediately outside the surgery. A long stay car park is located approximately two minutes’ walk from the practice.

The dental team includes two dentists, two dental nurses, two dental hygienists, and one receptionist. The practice has three treatment rooms, two at ground floor level and one at first floor level.

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 one dentist, two dental nurses, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open on Monday and Thursday from 8.30am to 5.45pm; on Tuesday from 8.30am to 7pm; on Wednesday from 8.30am to 1pm; and on Friday from 8.30am to 5pm. The practice closes each day for lunch between 1pm and 2pm.

Our key findings were:

Improvements had been made in relation to safety within the practice. This included:

• Comprehensive fire risk assessments, emergency lighting and a fire alarm system.
• Electrical safety of the building had been checked and certified.
• Individual risk assessments in place for staff using for hazardous substances and for staff who did not have confirmed immunity to blood borne viruses.
• Improved safety in respect of Legionella control.
• Improved infection control.
• Availability of all recommended emergency equipment and medicines.

Governance processes had also been reviewed and improved. This included:

• Effective systems in place to ensure medical alerts and treatment guidance updates were received and shared with all staff at the practice and actioned as appropriate.

• A system was in place for ensuring medical equipment reflected nationally recognised guidance.
• Effective management of risk assessments
• Improved audit across several areas.
• Maintenance work being undertaken throughout the practice.
• Improved management and maintenance of staff recruitment records

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

• Check the requirements for the emptying of waste water storage tanks in the basement of the premises, and whether this should be treated as clinical waste.

We carried out this announced inspection on 23 April 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 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 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

D B Allen Rawtenstall is in Rossendale, Lancashire and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. There is no car parking immediately outside the surgery. A long stay car park is located approximately two minutes’ walk from the practice.

The dental team includes 2 dentists, two dental nurses, two dental hygienists, and one receptionist. The practice has three treatment rooms, two at ground floor level and one at first floor level.

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 26 CQC comment cards filled in by patients. All feedback provided was positive.

During the inspection we spoke with two dentists, one dental nurse, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open on Monday and Thursday from 8.30am to 5.45pm; on Tuesday from 8.30am to 7pm; on Wednesday from 8.30am to 1pm; and on Friday from 8.30am to 5pm. The practice closes each day for lunch between 1pm and 2pm.

Our key findings were:

• The practice appeared clean and tidy. Clinical areas appeared to be well maintained.
• The provider had infection control procedures in place; these did not fully reflect published guidance. Our observations of staff showed that these were not routinely followed by all.
• Staff knew how to deal with emergencies.
• All appropriate medicines and life-saving equipment was not available, as described in recognised guidance.
• The practices systems to help them manage risk to patients and staff required review.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff recruitment procedures in place did not reflect recognised guidance and 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Leadership was present but required improvement.
• Staff felt involved and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• Information governance arrangements required improvement.

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.

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

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular, a risk assessment should be conducted in respect of the dental hygienist who routinely works without dental nurse support.

• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice. This should include annual audit to ensure adherence to protocol.