1 February 2019
During an inspection looking at part of the service
We undertook a follow-up focused inspection of Green Lane Dental Surgery on 1 February 2019. 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 Green Lane Dental Surgery on 7 August 2018 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. You can read our report of that inspection by selecting the 'all reports' link for Green Lane Dental Surgery on our website www.cqc.org.uk.
As part of this inspection we asked if care and treatment was:
• safe?
• 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 areas 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 breach we found at our inspection on 7 August 2018.
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 breach we found at our inspection on 7 August 2018.
Background
Green Lane Dental Surgery is in Liverpool and provides NHS and private treatment to adults and children.
The approach to the practice is served by three large stone steps, with level access beyond this point for people who use wheelchairs and those with pushchairs. Car parking spaces are available immediately in front of the practice and in front of the community pharmacy next door to the practice.
The dental team includes one dentist, three dental nurses, one of whom is the practice manager, and two part-time dental hygienists. The practice has two treatment rooms. A implantologist visits the practice to provide care and treatment as required.
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 the principal dentist, a dental nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open on Tuesday, Wednesday and Thursday from 8.45 am to 5.30pm; Monday from 8.45am to 7pm, and Friday from 8.45am to 2.00pm The practice closes for lunch Monday to Thursday from 1pm to 2pm.
Our key findings were:
The provider had taken sufficient steps to ensure that care and treatment was provided in a safe way to patients.
The provider had established effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
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The practice appeared clean and adequately maintained. Cleaning schedules were in place for all areas of the practice.
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All staff had received up to date infection control training; staff were aware of protocols for the flushing and management of dental unit water lines. Refresher training also covered the requirement for boxes used for the carrying of instruments between the surgery and decontamination room, to be scrubbed and decontaminated.
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Mops were stored correctly.
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Emergency medicines and equipment were available and ready for use, including emergency oxygen, sufficient to provide at least 30 minutes supply in an emergency.
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Weekly checks had been in place on the practice defibrillator. The practice had changed this to daily checks which were recorded.
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Staff were carrying out required tests on decontamination equipment, for example, the autoclave, to ensure required temperatures were being reached in the sterilising of dental instruments.
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Risk assessments were in place, in particular for Legionella management, fire risks and evacuation plans. Some items in the fire risk assessment required attention sooner rather than later. We discussed these with the principal dentist on the day of inspection, for example, the need to establish whether asbestos is present in some parts of the building.
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Copies of all checks required for recruitment of staff were available and held securely in staff files.
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Information governance overall had been improved. For example, the provider was now using an up-to-date audit tool for the audit of infection prevention and control.
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A log was in place to aid the secure and safe management of prescription pads. This enabled the practice to carry out prescribing audits.
The practice had made additional improvements. We saw that:
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Regular practice meetings were being held, where training needs for staff were being discussed.
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A training register was now in place allowing oversight of all staff training and any training requirements. All staff training was up to date.
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Appropriate products were being used for the cleaning of dental instruments.
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The provider had set a date for April 2019 when it would move to computerised record keeping.