Dr Baber Khan - The Crescent

We carried out this announced inspection on 13 September 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 that this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

The practice is in Spalding, a market town in the South Holland district of Lincolnshire. It provides private dental treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs at the rear of the premises. There are no car parking facilities, but on road parking is available for a limited time. There are also public car parks within close proximity to the practice. These include parking for blue badge holders.

The dental team includes one dentist, one dental hygienist and a practice manager. The practice manager had recently qualified as a dental nurse. A the time of our inspection, the provider was in the process of recruiting a dental nurse, as one working in the practice had recently left.

The practice has two treatment rooms, one on ground floor level and a separate decontamination room.

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.

We sent 50 comment cards in advance of our visit to the practice for patients to complete. On the day of inspection, we collected 7 CQC comment cards that had been filled in by patients. This represented a 14% response rate.

During the inspection we spoke with the dentist, dental hygienist, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday, Tuesday, Thursday and Friday from 9am to 5pm. It is closed on Wednesdays.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. We noted some improvements could be made when manual cleaning of dental instruments took place.
• All but one member of staff had received formal training in how to deal with emergencies. Appropriate medicines were available, but not all life-saving equipment.
• The provider had insufficient systems to help them manage risk to patients and staff.
• The provider did not have adequate safeguarding processes and not all staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider did not have a recruitment policy or procedure. We noted areas where legislative requirements were not met such as obtaining of references or other evidence of previous satisfactory conduct in employment for staff.
• We were not assured that clinical staff always provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• Staff were aware of the importance of patient confidentiality.
• The provider used a comment box to obtain feedback from patients.
• The provider had not received any formal complaints.
• The provider did not demonstrate effective leadership and a culture of continuous improvement.
• Staff changes had impacted upon the smooth running of the service.
• The provider demonstrated they were taking responsive action after the day of our visit.

We identified regulations the provider was not complying with. They must:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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:

• Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of dental dams for root canal treatment.
• Take action to ensure the clinicians take into account the guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’ when promoting the maintenance of good oral health.
• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Implement processes and systems for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.
• Take action to ensure the service takes into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.