Bridge House Dental Practice

We undertook an unannounced focused inspection of Bridge House Dental Practice on 10 November 2020. This inspection was carried out in response to concerns received by CQC and to review in detail the actions taken by the registered provider to improve the quality of care.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Bridge House Dental Practice on 25 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 well led care and was in breach of regulation 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 Bridge House Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• 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 (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required. As part of this inspection, we also focussed on aspects of safe and effective care as a result of concerns received by CQC.

Our findings were:

Are services safe?

We found this practice was 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 well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Bridge House Dental Practice is in Market Deeping, a market town in the South Kesteven district of Lincolnshire. It provides NHS and private dental treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs through an alternative entrance at the side of the practice. Car parking spaces are available at the rear of the premises in their own car park.

The dental team includes two dentists, one dental hygienist, two dental nurses; (one of the dental nurses also undertakes the role of practice manager) and one receptionist.

The practice has three treatment rooms; two are on ground floor level.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Bridge House Dental Practice is the principal dentist.

During the inspection we spoke with one dentist and two dental nurses (including the practice manager). We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday, Wednesday and Thursday from 8.30am to 5pm, Tuesday 8.15am to 6pm and Friday 8am to 4pm. The practice also opens on one Saturday a month from 9am to 1pm.

Our key findings were:

• The systems to assess, monitor and manage the risks to patient safety were working effectively. This included staff access to personal protective equipment (PPE) the storage of dental instruments and their decontamination.
• The practice was providing preventive care and supported patients to ensure better oral health in line with the Delivering Better Oral Health toolkit. Patient dental care records we looked at included information which reflected recommendations in national guidance.
• The processes for incident reporting required further improvement to ensure that they were identified and recorded as such. Learning outcomes shared amongst the team required recording.
• Safeguarding processes had been subject to review, although we identified where further input was required by the provider. We were informed of progress after the day of our visit.
• We saw evidence that staff appraisal had been implemented.
• We were informed that time had been allocated for audit activity. We viewed a recent infection prevention and control audit.
• Digital X-ray plates that were worn had been replaced since our previous visit.
• Risks that had not been previously effectively managed had been subject to mitigation, for example, fire and legionella. Some other risks were subject to ongoing review, for example, obtaining staff Hepatitis B immunity levels where this was not known.
• Recruitment processes had been improved such as obtaining new disclosure barring service (DBS) checks for staff. The process for seeking references for new staff required strengthening to ensure an audit trail could be demonstrated.
• Glucagon had been obtained for the medical emergencies kit.
• The provider had implemented a system for the receipt and review of medical safety alerts such as MHRA.
• A second oxygen cylinder had been obtained for use if required within the practice.
• Staff had discussed Gillick competency and consent to improve their knowledge of these issues.
• NHS prescription pads were held securely, but monitoring was required to ensure it could be identified if an individual prescription was taken inappropriately. Following our visit, we were sent information to show how this was being improved.

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

• Implement an effective system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Take action to ensure that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Implement an effective recruitment procedure to ensure that appropriate checks, references or other evidence of satisfactory conduct in previous employment are completed prior to new staff commencing employment at the practice.