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Inspection carried out on 25 March 2020

During a routine inspection

We undertook a follow up desk-based inspection of East Street Dental Centre on 25 March 2020. 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 remotely by a specialist dental adviser.

We undertook a comprehensive inspection of East Street Dental Centre on 1 October 2019 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 well-led care and was in breach of regulations 17 and 18 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 East Street Dental Centre on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it 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 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 breaches we found at our inspection on 1 October 2019.

Background

East Street Dental Centre is in Bedminster, Bristol and provides NHS and private dental treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs. Patients whose mobility needs require level access are directed or referred to a nearby practice with level access. Car parking is available near the practice both on street and in a nearby car park.

The dental team includes two dentists, a dental hygienist, three dental nurses including one trainee dental nurse, a practice manager and one receptionist. The practice has four treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered. The current practice manager is in the process of becoming the registered manager with CQC.

The practice is open:

Monday to Thursday: from 8.30am to 6.30pm and Friday: 8.30am to 5.30pm.

Our key findings were:

  • The decontamination areas had been reviewed and additional shelving had been installed to ensure a positive flow of dental instruments from the dirty area to the clean.
  • All staff had received infection control training since the last inspection.
  • Systems and processes had been introduced to ensure single-use dental items were not re-used.
  • All clinical staff had up-to-date indemnity insurance.
  • All clinical staff at the practice had documentation identifying they had immunity to the Hepatitis B virus. The receptionist had a risk assessment relating to Hepatitis B on file.
  • All staff had undergone a valid Disclosure and Barring Service check.
  • An external contractor had surveyed the flat roof, and produced a report identifying this area was safe.
  • Radiation procedures at the practice had been reviewed and updated.
  • All staff had received fire safety training since the last inspection on 1 October 2019.
  • A change of in-house management has resulted in a review of the supervision and support arrangements for staff.
  • All staff had completed life support and medical emergencies training.

Inspection carried out on 01 October 2019

During a routine inspection

We carried out this announced inspection on 01 October 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 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

East Street Dental Centre is in Bedminster, Bristol and provides NHS and private dental treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs. Patients whose mobility needs require level access are directed to a nearby practice. Car parking is available near the practice both on street and in a nearby car park.

The dental team includes four dentists, two dental nurses and four trainee dental nurses; one dental hygienist, a practice manager and three receptionists. The practice has four treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager.

Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at East Street Dental Centre is the practice manager.

On the day of inspection, we collected 20 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with four dentists, two dental nurses, two trainee dental nurses, two receptionists 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 to Thursday 08.30am – 6.30pm
  • Friday 08.30am – 5.30pm
  • Closes at weekends

Our key findings were:

  • The practice appeared clean and mostly well maintained. Improvements could be made to address issues of rusty and broken equipment in a timely way.
  • The provider had infection control procedures which mostly reflected published guidance. Improvements could be made to the layout of the decontamination areas, staff training and knowledge of infection control.
  • Improvements were required to ensure all staff had received training and knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
  • The provider had limited systems to help them manage risk to patients and staff. Improvements could be made to ensure identified risks are addressed in a timely manner and appropriately recorded.
  • The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • The provider had staff recruitment procedures but not all required information was present in the practice when requested.
  • The clinical staff 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.
  • Staff provided preventive care and supported patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider had limited leadership. Improvements could be made to engender a culture of continuous improvement.
  • Staff felt involved and worked well as a team.
  • The provider asked staff and patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements.

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

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

  • Improve the practice protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
  • Implement a system to ensure patient referrals to other dental or health care professionals are centrally monitored to ensure they are received in a timely manner and not lost.
  • 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 6 December 2013

During a routine inspection

East Street Dental Centre provided primary dental care to private and NHS patients. There were four surgeries operating within the practice.

People told us that they were happy with the service they received at the practice. They told us that they had been coming there for a long time, and had got to know the dentists and other staff. One person told us � they are very polite and reassuring�.

We observed people interacted well with staff in the reception area. People told us they felt comfortable when they asked questions and that staff were polite and helpful. People felt they were treated with dignity and respect when they visited the practice.

People told us that the dentist always discussed treatment options with them. One person we spoke with said they had always been informed of the cost of their treatment and they had signed a consent form. People said they were able to ask questions about their treatment and were kept informed.

Overall, we found that the provider was operating effective systems to ensure patients received suitable care and treatment in a clean environment. We had a couple of minor concerns, which we discussed with the registered manager and the practice support manager during the inspection. These related to portable electrical testing (the examination of electrical appliances and equipment to ensure they are safe to use). The other was in relation to providing a piece of equipment that ensured infection control process was completed.