We undertook a focused inspection of Woolton Dental Practice on 5 August 2020. We have undertaken enforcement action and have applied conditions to the registration of this provider, in relation to the governance, management and leadership at the practice. The conditions will be reviewed when the Care Quality Commission (CQC) have re-inspected the practice, and are satisfied that governance, management and leadership have improved.
The inspection was led by a CQC inspector who was supported by a second CQC Inspector and a specialist dental adviser.
We undertook a comprehensive inspection of Woolton Dental Practice on 11 June 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.
At a follow-up inspection of the practice on 17 December 2019, we found some improvements had been made in respect of safe care and treatment. The improvements made in relation to governance and leadership of the practice, were insufficient to meet the threshold required, and we found evidence of on-going breaches of Regulation 17 and breaches of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We visited the practice on 5 August 2020 to assess whether any improvements had been made given the time to review systems, policies and processes.
You can read our report of inspections by selecting the 'all reports' link for Woolton Dental Practice on our website www.cqc.org.uk.
As part of this inspection we asked:
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 17 December 2019.
Some areas requiring further improvement which fell within the safe key line of enquiry, were due to insufficient management oversight and governance processes. These issues are covered in the well-led key question, below.
Are services well-led?
We found this practice was not providing well-led care in accordance with the relevant regulations.
The provider had made some improvements but these did not address all matters brought to the attention of the provider at our last inspection. We also found some further concerns during this follow-up inspection. The provider had not fully responded to the regulatory breaches we found at our inspection on 17 December 2019.
Background
Woolton Dental Practice is located in south Liverpool and provides NHS and private treatment for adults and children.
There is level access for people who use wheelchairs and those with pushchairs. A small amount of car parking is available near the practice.
The dental team includes two dentists, three dental nurses, one receptionist, and one dental hygienist. The practice has four treatment rooms, two at ground floor level and two at first floor level. There is an additional treatment room on the ground floor, but this is not in use. The first floor is accessible via a staircase.
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 a dental nurse, a receptionist, the practice manager, the associate dentist and the principal dentist.
The practice opens and closes at different times each day: Monday the practice is open from 9am to 1pm and from 2pm to 7.30pm; Tuesday the practice opens from 8am to 12.30pm and from 1.30pm to 5pm; Wednesday the practice opens from 8.30am to 1pm and from 2pm to 5pm. Thursday the practice is open from 9am to 1pm and from 2pm to 5.30pm; Friday the practice opens from 8am to 12pm and from 1pm to 4.30pm. The practice also opens on Saturday to accommodate patient demand.
Our key findings were:
- Improvements in relation to recruitment and recruitment records had been made and all required documentation was held by the provider; this included the instances when the provider had used locum staff.
- All emergency medicines and equipment as described in nationally recognised guidance was ready and available for use.
- There was a system in place for receipt, sharing and recording emergency medical alerts and notices.
- There was evidence of practice meetings available for review, supporting communication across the practice.
- Labels were available for dispensing medicines from the practice. These labels contained all required information about the practice/dispenser, and space was available for inclusion of patient name, medicine, strength, dose and duration of course.
- Essential checks in relation to gas and electrical safety for the premises had been carried out.
- Staff had access to sufficient quantities of personal protective equipment and other consumables.
- A complaints policy was in place and available for staff to refer to.
However, we found there were a number of points identified at our last inspection that the provider had not fully addressed.
- The policy on whistle blowing had been updated, but still did not contain details on how to contact the General Dental Council (GDC), for staff to refer to if needed.
- Although local rules for X-ray equipment had been updated, for two of the X-ray sets, the isolation switch for the set was within the controlled area. Local rules had not been adapted to include and mitigate this risk.
- A redundant X-ray set had not been isolated from its power supply or decommissioned.
We identified further concerns at our inspection on 5 August 2020.
- The provider was not addressing all known risks as they arose. For example, in relation to risk assessments for staff, risk assessments for vulnerable patients and risks in relation to Legionella management.
- Policies in relation to COVID security of the practice required review and was not being adhered to by staff.
- Essential paperwork which a provider must be able to show the regulator was not available; this was in relation to Legionella training, fit testing of respirator masks and log sheets to support their safe use.
- The provider failed to demonstrate awareness of the guidance for washing re-usable gowns, tunics and scrubs. The provider displayed no awareness of The Water Supply (Water Fittings) Regulations 1999, in relation to the instalment of a washing machine at the practice, used to launder all staff workwear.
- A lack of effective systems, processes and audit had failed to identify that an ongoing proportion of clinical patient records did not meet recognised standards.
We identified regulations the provider was not meeting. 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.