We carried out an unannounced comprehensive inspection on 23 June 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 not 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
The Elephant & Castle Dental Clinic is located in the London Borough of Southwark. The premises are situated in a high-street location. There are four treatment rooms, a decontamination room, a reception room with waiting area, and a patient toilet across the ground, first and second floors of the building.
The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.
The staff structure of the practice consists of a principal dentist, three associate dentists, a dental nurse, three trainee dental nurses, and two receptionists, who are also qualified dental nurses. There is also a part-time practice manager.
The practice opening hours are on Monday, Tuesday, Thursday and Friday from 9.00am to 5.30pm, and on Wednesday from 9.00am to 6.30pm. The practice is also open from 9.00am to 1.30pm on Saturdays.
The principal dentist 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.
The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.
Three people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.
Our key findings were:
- Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
- The systems in place to reduce and minimise the risk and spread of infection were ineffective.
- The practice had a safeguarding policy in place. However, staff did not understand their responsibilities for safeguarding adults and children living in vulnerable circumstances.
- Staff reported accidents, but there were no other arrangements in place for reporting and learning from incidents.
- There were arrangements in place for managing medical emergencies. However, we found that some items of equipment and medicines required for the management of medical emergencies were not available.
- Equipment, such as the air compressor and X-ray equipment had been checked for effectiveness and had been serviced. However, other items, such as fire extinguishers and the ultrasonic bath, had not been well maintained or tested for effectiveness.
- Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team. However, the systems for obtaining patient feedback, with a view to monitoring the quality of care, needed to be improved.
- The practice had not monitored staff training to ensure they maintained the necessary skills and competence to support the needs of patients.
- The practice had not effectively implemented procedures for managing comments, concerns or complaints.
- There were some governance arrangements in place for the smooth running of the practice. However, the practice did not have a structured plan in place to monitor quality and safety. The practice had not effectively monitored and mitigated the risks associated with carrying out the regulated activities.
We identified regulations that were not being met and the provider must:
- Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).
- Ensure the practice’s infection control procedures and protocols are suitable taking into account 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 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. The practice should ensure that 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 systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
- Ensure that the practice has appropriate procedures and implements relevant processes to safeguard people. Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
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 system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
- Review availability of medicines and 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.
- Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
- Review staff awareness of, and training in relation to, Gillick competency and the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities as it relates to their role.
- Review the practice’s responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
- Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013
- Review the practice’s complaints handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.
- Review the practice’s responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.
- Review the availability of an interpreter service for patients who do not speak English as their first language.
- Review the systems for checking and monitoring equipment to ensure that all equipment is well maintained.