Updated 5 February 2019
We carried out this announced inspection on 15 January 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. We had also received a number of complaints about the practice. 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 this practice was not providing safe care in accordance with the relevant regulations.
Are services effective?
We found this practice was providing effective care in accordance with the relevant regulations.
Are services caring?
We found this practice was providing caring services in accordance with the relevant regulations.
Are services responsive?
We found this practice was providing responsive 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
177 Unthank Road Dental Surgery is based in Norwich and offers mostly NHS treatment. The dental team is small, consisting of one dentist and one dental nurse. An agency dental nurse also works at the practice four days a week. There is one treatment room. There is ramp access for people who use wheelchairs and those with pushchairs. On street parking is available a short walk from the practice.
The practice opens Mondays to Fridays from 9am to 5pm.
The practice is owned by an individual who is the principal dentist there. He has 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 19 CQC comment cards filled in by patients and spoke with one other patient.
During the inspection we spoke with the dentist and two nurses. We looked at practice policies and procedures and other records about how the service is managed.
Our key findings were:
- Staff treated patients with dignity and respect, and we received many positive comments from patients about the caring and empathetic nature of the dentist and nurses.
- Infection control procedures reflected published guidance and the practice appeared clean and well maintained.
- Patients received their care and treatment from staff who enjoyed their work. Staff felt involved and supported and worked well as a team.
- Patients’ dental care was mostly delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.
- The management of risk in the practice was limited and potential hazards had not been assessed adequately.
- Some equipment had not been properly serviced or maintained.
- Patients’ confidential dental care records were not stored securely in line with guidance.
- The practice did not have a plan in place to audit quality and safety. Staff had not received formal appraisal of their performance.
We identified regulations the provider was not meeting. 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 was not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Review the practice’s protocols for the use of rubber dams for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
- Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and Gillick competence and ensure all staff are aware of their responsibilities under the Act as it relates to their role.