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Inspection carried out on 12 December 2019

During an inspection looking at part of the service

We undertook a follow up focused inspection of The Dental Care Clinic on 12 December 2019.

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 had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of The Dental Care Clinic on 28 May 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 19 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 The Dental Care Clinic 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.

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 28 May 2019.

Background

The Dental Care Clinic is in Newcastle upon Tyne and provides NHS and private treatment to adults and children.

There is level access to the practice and car parking spaces are available near-by.

The dental team includes the principal dentist, ten associate dentists, 16 dental nurses, a treatment co-ordinator and two dental hygienists. Reception duties are carried out by the dental nurses and the treatment co-ordinator. A practice manager and a deputy practice manager oversee the day to day running of the practice. The practice has eight treatment rooms over two floors.

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 The Dental Care Clinic was the practice manager.

During the inspection we spoke with the principal dentist and the practice managers. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Tuesday 8.30am to 7.20pm

Wednesday 8.30am to 5.10pm

Thursday 8.30am to 6.20pm

Friday 8.30am to 4.20pm

Our key findings were:

  • The practice had effective leadership with improved systems to allow for continuous improvement.
  • Risks to patients and staff were reviewed, assessed and managed in relation to fire, Legionella, hazardous substances, electrical appliance safety, lone working, radiation protection, and carrying out domiciliary care.
  • The provider had improved their staff recruitment procedures and systems to monitor staff training.
  • Medical emergency drugs and equipment were now available in line with recognised guidance. The provider had improved their systems to monitor these.
  • Improvements were found in the practice’s implant audit processes.
  • Prescriptions were monitored in line with national recommendations.
  • The provider had assessed the needs of patients with disabilities to comply with the requirements of the Equality Act 2010.
  • The practice reviewed their infection control procedures and protocols for the use of a closed-circuit television system.

Inspection carried out on 28 May 2019

During a routine inspection

We carried out this announced inspection on 28 May 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 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

The Dental Care Clinic is in Newcastle upon Tyne and provides NHS and private treatment to adults and children.

There is level access to the practice and car parking spaces are available at the practice and near-by.

The dental team includes the principal dentist, ten associate dentists (one of whom is newly qualified and is undergoing vocational training), 14 dental nurses (seven of whom are trainees), a treatment co-ordinator and two dental hygienists. Reception duties are carried out by the dental nurses and treatment co-ordinator. A practice manager and a deputy practice manager oversee the day to day running of the practice. The practice has eight treatment rooms over two floors.

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 The Dental Care Clinic was the practice manager.

On the day of inspection, we collected 32 CQC comment cards filled in by patients. These provided a positive view of the practice.

During the inspection we spoke with both practice managers, four dentists, four dental nurses and reception staff. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Tuesday 8.30am to 7.20pm

Wednesday 8.30am to 5.10pm

Thursday 8.30am to 6.20pm

Friday 8.30am to 4.20pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider should review their infection control procedures to ensure they follow national guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available apart from oxygen face masks. The provider should review the storage of medical drugs and dental anaesthetics to ensure they are stored securely and in accordance with manufacturer’s recommendations.
  • The practice had systems to help them manage risks. The provider should review their systems for assessing and controlling the risks associated with running their dental practice.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information. The practice had a closed-circuit television system on the premises; there was no policy or data protection impact assessment in place to support its use.
  • The appointment system met patients’ needs.
  • The provider should review their practice leadership to ensure it promotes a culture of monitoring for continuous improvement.
  • Staff felt involved and supported and worked well as a team.
  • The practice asked staff and patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The practice had suitable information governance arrangements.
  • The system to monitor staff training needed review.

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

  • 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.

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

  • Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular, their method for transporting of instruments and validation checks of equipment used in sterilisation.
  • Review the practice’s protocols for the use of closed-circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.
  • Review the practice's responsibilities to assess and take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.