Archived: D W Ferns Dental Surgery

We carried out this announced inspection on 2 July 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 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

D.W Ferns is a well-established dental practice based in Lowestoft that offers NHS general treatment to both children and adults. Another provider is located at the same address, and although registered separately, they both operate as one service, with shared expenses, staff and governance arrangements.

The dental team consists of a dentist, three dental nurses, and two receptionists (who are also shared with the other dentist located on the premises). There are two treatment rooms. The practice opens on Mondays to Fridays from 9 am to 5.30 pm.

There is level access for wheelchair users and on street parking close by.

The practice is owned by an individual who is the 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 48 CQC comment cards filled in by patients and spoke with another three.

During the inspection we spoke with the dentist, two nurses and the receptionist. We also spoke with three patients. 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.

• The practice was small and friendly, something which both patients and staff appreciated.

• The practice appeared clean and well maintained.

• Infection control procedures reflected published guidance and legionella was managed well.

• The appointment system met patients’ needs and patients could get an emergency appointment easily.

• Patient dental care records did not reflect standards set by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• The management of risk in the practice was limited and identified hazards had not been managed adequately.

• The dentist did not into account guidelines as set out by the British Society for Disability and Oral Health when providing dental care in domiciliary settings such as care homes or in people’s own homes.
• Staff did not receive a regular appraisal of their performance or training needs

• Governance procedures were not robust and audit systems were not effective in driving improvement.

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 dental dams for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017.

• Review staff understanding of the Mental Capacity Act and Gillick competency guidelines so that they are aware of their responsibilities in relation to them.