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Inspection carried out on 8 January 2020

During an inspection looking at part of the service

We undertook a follow up focused inspection of West Norwood Dental Surgery on 8 January 2020. 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 West Norwood Dental Surgery on 30 October 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 regulation of 12 -Safe care and treatment and Regulation 17 - Good governance under 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 West Norwood Dental Surgery 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 area 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 breaches we found at our inspection on 30 October 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 breaches we found at our inspection on 30 October 2019.

Background

West Norwood Dental Surgery is in West Norwood and provides NHS and private treatment to adults and children.

Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes a dentist and a trainee dental nurse. The practice has one treatment room and decontamination area.

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 both with the dentist and the trainee dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

  • The practice had recruited a new trainee dental nurse and had details of the training course the trainee nurse was attending

  • The practice had serviced pressure valves and other equipment used

  • The practice had undertaken an electrical condition report and Gas safety check.

  • The practice had purchased new firefighting equipment

  • There were appropriate medicines to deal with medical emergencies

  • The dentist had made the decision to stop carrying out domiciliary care services.

  • The ripped floor lining in the treatment room had been repaired and new carpet had been ordered for the reception area

  • The practice had carried out radiography and infection control audits.

  • The practice had a complaints policy and complaints leaflet that advised patients how to make complaints

  • The practice had undertaken a sharps risk assessment

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

  • Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.

  • Review the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.

Inspection carried out on 30 October 2019

During a routine inspection

We carried out this unannounced inspection on 30 October 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 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

West Norwood Dental Surgery is in West Norwood and provides NHS and private treatment to adults and children.

Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes a dentist, a dental nurse and a trainee dental nurse. The practice has one treatment room and decontamination area.

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 received feedback from four patients.

During the inspection we spoke both with the dentist and the dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

  • Improvements were required in the appearance and cleanliness of the practice, including attending to the rip in the waiting room carpet.

  • The dentist generally provided patients’ care and treatment in line with current guidelines.
  • Staff were providing preventive care and supporting patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider asked staff and patients for feedback about the services they provided.
  • The dentist had some understanding of how to deal with medical emergencies. Some medicines and life-saving equipment were available on the premises. However, there were some improvements required including replacing out of date adrenaline.
  • Improvements were required to the provider’s infection control procedures.
  • The practice had some systems in place to help them manage risk to patients and staff.
  • The dentist was not up to date with key training such as safeguarding children and vulnerable adults and improvements were required to their safeguarding policy.
  • The provider did not carry out all the required recruitment checks for staff employed
  • The provider did not have systems in place to audit their non-clinical and clinical processes.

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

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure patients are protected from abuse and improper treatment
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

There were areas where the provider could make improvements.

They should:

  • Take action to ensure the clinicians take into account the guidance provided by the Faculty of General Dental Practice when completing dental care records. In particular in regard to recording patients consent .

  • Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
  • Review the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.

  • Improve and develop the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.

  • Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.

Following our inspection the provider informed us that their trainee nurse who provided chairside assistance had resigned and the practice would stop undertaking regulated activities while they undertook a process to recruit a new dental nurse.

Inspection carried out on 18 November 2016

During a routine inspection

We carried out an announced comprehensive inspection on 18 November 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 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 providing well-led care in accordance with the relevant regulations.

Background

West Norwood Dental Surgery is a NHS dental practice in Lambeth. The practice is situated in a converted residential property. The practice is set out over two floors and has one dental treatment room, a patient waiting room with reception, a separate decontamination room for cleaning, sterilising and packing dental instruments and a staff office.

The practice is open 10.00am to 3.00pm Monday, Wednesday and Thursdays. The practice is also open on Tuesday and Fridays for administration purposes although if a patient had a dental emergency they would be seen on these days.

The practice staffing consisted of one dentist and a dental nurse.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual ‘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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 49 patients via completed comment cards. Patients provided a positive view of the services the practice provides. They commented on the quality of care, the friendliness and professionalism of all staff, the cleanliness of the practice and the overall quality of customer care.

Our key findings were:

  • Both staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines. Some of the recommended equipment however was not available.
  • The practice appeared clean and well maintained.
  • Infection control procedures were in place however audits were not being completed.
  • The principal dentist was the safeguarding lead.. Both staff members demonstrated knowledge of safeguarding.
  • The practice had a system in place for reporting incidents which the practice used for shared learning.
  • The dentist provided dental care in accordance with current professional and National Institute for Health and Care Excellence (NICE) guidelines.
  • Governance arrangements were in place however not all risks associated with carrying out regulated activities were being considered.
  • The service was aware of the needs of the local population and took these into account in how the practice was run.
  • Patients could access treatment and urgent and emergency care when required.
  • Staff recruitment files were in order and included relevant pre recruitment documents such as, CVs and references.
  • Staff had the opportunity to attend learning and training events.
  • The dental nurse we spoke with felt well supported by the practice owner and both staff members were committed to providing a quality service to their patients.
  • Feedback from patients gave us a positive picture of a friendly, caring and professional service.

There were areas where the provider could make improvements and should:

  • Review governance arrangements to ensure there are effective systems established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities, including the storage of dental care records. Review availability of equipment and staff training 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 practice’s infection control procedures including assessment of legionella and protocols giving due regard to 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.
  • Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
  • Review the practice’s audit protocols of various aspects of the service, such as radiography and dental care records at regular intervals to help improve the quality of service. Practice should also check, where applicable audits have documented learning points and the resulting improvements can be demonstrated.

Inspection carried out on 13 February 2014

During a routine inspection

We did not speak to people using the service during our inspection as there were no patient appointments booked on that day. However, we did review patient satisfaction questionnaires and read feedback comments that patients had left.

We looked at seven patient records during our inspection; we saw evidence that proposed treatment plans and the cost of treatment were recorded.

There were arrangements in place to deal with foreseeable emergencies. Portable oxygen, a first aid and an emergency drugs box were available at the practice. Medication was within the use by date and the oxygen was checked on a weekly basis.

We spoke with the dental nurse about the cleaning procedure they followed at the practice and observed them while they showed us the process used for sterilising used instruments. The nurse told us that they followed a checklist to maintain cleanliness at the beginning of the day and in between patients.

The dentist showed us evidence confirming that they completed the required number of hours to maintain their registration with the General Dental Council (GDC).