Archived: Dr Graham Owens Dental Surgery

We carried out an announced comprehensive inspection on 10 December 2015 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 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

Dr Graham Owens Dental Surgery is located in the London Borough of Westminster. The premises are situated on the ground floor of a building where other health care providers are also situated. There is one treatment room, a dedicated decontamination room, and a reception area. There is also a shared waiting room and patient toilets on the ground floor.

The practice provides private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.

The staff structure of the practice consists of a locum dentist and locum nurse, and a practice manager who is also a trained dental nurse. The principal dentist (and owner) was not practicing at the location, at the time of our inspection, due to an unexpected prolonged absence.

The practice opening hours are on Monday, Tuesday, and Thursday from 9.30am to 6.00pm. The practice also opens occasionally on a Wednesday.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Seven people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances. However, not all staff had received formal training in safeguarding vulnerable patients.

• Equipment, such as the air compressor, autoclave (steriliser), and X-ray equipment had all been checked for effectiveness and had been regularly serviced.

• Staff knew how to report incidents and how to record details of these so that the practice could use this information for shared learning.

• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.

• The practice did not have effective systems to reduce and minimise the risk and spread of infection.
• There was no formal recruitment policy, and not all relevant background checks had been carried out prior to staff employment.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• The practice had not identified all of the additional training required for specialist roles, such as the training required for staff involved in the provision of conscious sedation.
• Governance arrangements were not robust; audits and risk assessments were not used effectively to drive improvements in the quality of the service.

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

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure the practice’s infection control procedures and protocols meet current 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.
• Ensure the practice’s protocols for conscious sedation are suitable giving due regard to guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.
• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.

• Ensure audits of various aspects of the service, such as infection control, radiography and dental care records, are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.

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

• Review availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the use of risk assessments as a process for minimising risks to patients and staff.

• Review stocks of medicines and equipment and establish a system for identifying, and disposing of out-of-date stock.
• Review the information contained within the Control of Substances Hazardous to Health (COSHH) Regulations 2002 file to ensure that it is up to date and all staff understand how to minimise risks associated with these substances.
• Review the storage of dental care records to ensure they are stored securely

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