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Dr Baber Khan - The Crescent

Reports


Inspection carried out on 13 September 2019

During a routine inspection

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.

Inspection carried out on 14 March 2014

During an inspection to make sure that the improvements required had been made

We inspected the service in November 2013 we found the provider did not have systems in place to reduce the risk of infection or to monitor the quality of the service people received. We visited on 14 March 2014 to check what improvements the provider had made. We spoke with the provider and the three members of staff who worked at the practice.

We found the practice environment was generally clean and tidy. The provider and the dental nurse were wearing short sleeved tunics which appeared clean.

The provider had identified the dental nurse as the designated lead for infection prevention and control. The dental nurse demonstrated a clear knowledge and understanding of the systems and arrangements in place.

We saw policies had been updated and reflected the latest guidance and audits had been competed to identify areas for improvement.

Records showed contracts were in place to ensure equipment was serviced and met required standards. Environmental risk assessments were in place to ensure people and staff were protected from risks relating to disposing of waste, radiation and fire.

Inspection carried out on 18, 21 October and 8 November 2013

During an inspection in response to concerns

We visited the service on 18 October 2013 as we had received some information of concerns about the provider. The dental nurse who was the designated infection control lead was not available on 18 October 2013 so we went back to the service on 21 October 2013 to speak with them. We also visited on 8 November 2013 to check compliance with outstanding compliance actions. A specialist advisor who was a dentist visited with us on 18 October 2013 and 8 November 2013.

When we visited on 8 November 2013 the provider informed us all the permanent staff had left their employment and they were working with temporary staff to provide a service to people.

We saw people received the care they needed. They were involved in discussions about their care and were given time to make decisions. One person told us, �You can think about it and the cost.�

Systems for ensuring people were protected from the risk of infection were not always followed correctly. Infection control audits were not completed accurately.

Staff were supported to access training and receive appraisals.

The provider did not have robust arrangements in place to monitor the quality of the service people received. They did not respond to advice from professionals and did not complete appropriate audits to identify areas for improvement.

Inspection carried out on 18 March 2013

During an inspection to make sure that the improvements required had been made

Dr Baber Khan � The Crescent currently has one dentist. The patients are all private. We visited to check if they were compliant with a warning notice we issued following our visit in 22 January 2013. We spoke with two members of staff and the dentist.

When we visited on 22 January 2013 we saw decontamination processes were not always effective in reducing the risk of infection. We also identified the cleaning schedule did not support identified infection control standards.

When we visited on 18 March 2013 we saw there was a good improvement in the cleanliness of the clinical and non clinical areas. Cleaning processes were in place and records showed daily cleaning was happening.

The decontamination process had been reviewed. A disinfecting cleaning solution was used to scrub dirty instruments and all instruments were visually inspected. Records showed the autoclave was tested and working correctly each day. However, we saw there was no hand washing facilities in the decontamination room.

Inspection carried out on 22 January 2013

During a routine inspection

Dr Baber Khan � The Crescent currently has one dentist. The patients are all private. We spoke with two members of staff, one dentist and a patient who was visiting the service at the time of our visit.

The patient told us the dentist discussed their treatment options. They said, "I always get a treatment plan and have a good idea of what�s happening.�

The patient told us the dentists and dental nurses wore protective equipment, for example gloves, to reduce the risk of infection. However we saw decontamination processes were not always effective in reducing the risk of infection. We also identified the cleaning schedule did not support identified infection control standards.

We saw the emergency medication was not all within their expiry dates. We also saw some of the recommended medication was not available.

Members of staff told us they had not received any training in the last 15 months. They also said they did not have yearly appraisals or regular supervision to support them and indentify training needs.

We saw risks to people were not always identified or managed. Routine audits to monitor the quality of the service provided did not happen.