Archived: Mr Richard Hurst - Cramlington

We carried out a follow-up inspection at Mr. Richard Hurst – Cramlington dental practice on the 31 July 2017.

We had previously undertaken an announced comprehensive inspection of this service on the 14 March 2017 where a breach of legal requirements was found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach This report only covers our findings in relation to those requirements.

We reviewed the practice against one of the five questions we ask about services: is the service well-led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Richard Hurst’s dental practice on our website at www.cqc.org.uk.

We reviewed documentation as part of this inspection and checked whether they had followed their action plan. This was to confirm that they now met the legal requirements.

Our findings were:

Are services well-led?

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

Background

Mr. Richard Hurst – Cramlington dental practice is situated in the centre of Cramlington and provides private dental treatment to adults and NHS dental treatment to children. There is level access for people who use wheelchairs and pushchairs. Car parking is available at the front of the practice and also in a car park nearby.

The dental team is comprised of a principal dentist, two associate dentists, three dental nurses and a receptionist. One of the dental nurses also provides management support.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Registered persons 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 looked at practice policies and procedures and other records about how the service is managed.

The practice is open

Monday and Thursday 0830 - 1800

Tuesday and Friday 0830 -1700

and Wednesday 0830-1230.

Our key findings were:

• The practice’s infection control procedures reflected published guidance.
• Appropriate medicines and life-saving equipment were available to deal with medical emergencies.
• Procedures for storage and monitoring of the medicines and equipment were apparent.
• The practice had systems to help them manage risk and the principal dentist had undertaken a health and safety and fire risk assessment of the premises.
• The practice had implemented robust staff recruitment procedures including procedures for risk assessing and monitoring non-responders to Hepatitis B vaccinations.

• The practice's policies were reviewed and signed by all staff.
• Procedures for carrying out audits of the service at regular intervals were in place.
• Recommendations from the X-ray equipment maintenance reports had been implemented.
• The waste contract had been reviewed and amended to comply with legal requirements.

We carried out an announced comprehensive inspection on 14 March 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Richard Hurst’s dental practice is situated in the centre of Cramlington and provides private dental treatment to adults and NHS dental treatment to children. The practice is housed in a listed building and comprises three treatment rooms, a decontamination area for sterilising dental instruments within one of the treatment rooms, a combined reception and waiting room (with a dedicated childrens’ area), an X-ray room, staff kitchen and general office. Car parking is available at the front of the practice and also in a car park nearby. Access for wheelchair users or pushchairs is possible via the step-free ground floor entrance.

The practice is open

Monday and Thursday 0830 - 1800

Tuesday and Friday 0830 -1700

and Wednesday 0830-1230.

The dental team is comprised of a principal dentist, two associate dentists, three dental nurses and a receptionist. One of the dental nurses also provides management support.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We reviewed seven CQC comment cards on the day of our visit; patients were very positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

• Staff were very friendly, caring and enthusiastic.
• The practice was visibly clean and free from clutter.
• The practice had systems for recording incidents and accidents.
• Staff underwent annual medical emergency training and had sufficient emergency drugs and equipment to deal with medical emergencies.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Patients could access urgent care when required.
• Complaints were dealt with in an efficient and positive manner.
• Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration.
• Practice meetings were used for shared learning.
• Patient feedback was regularly sought and reflected upon.
• Staff were aware on how to escalate safeguarding issues for children and adults should the need arise.
• The principal dentist received safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) and distributed these amongst all staff within the practice.
• The practice was involved in a national oral health research programme which looks at clinical and cost effectiveness of filling decay in children's primary (baby) teeth.
• We saw sterilisation procedures did not follow recommended guidance.
• The principal dentist had not regularly reviewed the practice’s protocols or policies.
• Recruitment procedures were not consistent.
• The principal dentist had not arranged for, or undertaken, a fire risk assessment of the premises.
• X-ray waste was not being disposed of in line with current guidance.
• Auditing of various aspects of the service was not consistent.

We identified regulations that were not being met and the provider must:

• Ensure they are meeting their legal obligations under Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Ensure they are meeting their legal obligations under the Regulatory Reform (Fire Safety) Order 2005.
• Ensure they are meeting their legal obligations under the Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure they are meeting their legal obligations under the Hazardous Waste (England and Wales) Regulations 2005 giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).

You can see full details of the regulation not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the practice's policies to ensure they contain appropriate details, are dated and reviewed at regular intervals.
• Review the practice procedures for carrying out audits of all aspects of the service at regular intervals, documenting learning points and improvements and sharing these amongst all relevant staff.
• Review the practice’s procedure for sterilisation and infection control taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05:Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the practice’s procedures for monitoring and /or risk assessing non-responders to Hepatitis B vaccinations.
• Review the practice’s procedures for storage and monitoring of their medical emergency drugs and equipment taking into account the guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.