Updated 6 September 2019
We undertook a follow-up focused inspection of Haymans Green Dental Practice on 6 August 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 was supported by a specialist dental adviser.
We undertook a comprehensive inspection of Haymans Green Dental Practice on 5 June 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 safe or well-led care and was in breach of regulations 12 and 17 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 Haymans Green Dental Practice on our website www.cqc.org.uk.
As part of this inspection we asked:
• Is it safe?
• Is it well-led?
When one or more of the five questions are not met we require the service to make improvements. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.
Our findings were:
Are services safe?
We found this practice was providing safe care in accordance with the relevant regulations.
The provider had made improvements in relation to the regulatory breaches we found at our inspection on 5 June 2019.
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 5 June 2019.
Background
Haymans Green Dental Practice is in the West Derby area of Liverpool and provides NHS and private treatment for adults and children.
There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.
The dental team includes four dentists, five full time dental nurses, one of whom provides reception cover, two part-time receptionists and two treatment co-ordinators who also provide reception cover. The practice team is led by a practice manager, supported by an assistant practice manager who is also a treatment co-ordinator. The practice was hosting a foundation dental hygiene therapist. Foundation training is a programme for new or recently qualified dental hygiene therapists. It is designed to support them in their first year in practice, including supervision and monitoring.
The practice has five treatment rooms, three at ground floor level and two on the first floor.
The practice is owned by a partnership 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 Haymans Green Dental Practice is the principal dentist.
During the inspection we spoke with one dentist, one dental nurse, one foundation dental hygiene therapist, the practice manager and deputy practice manager. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open: Monday to Friday between 8am and 5pm.
Our key findings were:
- The provider had infection control processes and procedures in place that reflected recognised guidance. Audit to support governance in this area was in place.
- All staff had received training in how to respond and deal with medical emergencies.
- Not all required emergency equipment was available and ready for use.
- Some emergency medicines were not available as described in recognised guidance.
- Checks on emergency equipment were still being made against an out of date check list.
- Processes to ensure all staff recruitment checks were in place had been strengthened. These were working effectively.
- No sedation treatment was being provided by the practice. The provider confirmed that this would no longer be carried out at the practice due to low numbers of patients seeking this treatment.
- Medicines management and the management and secure storage of NHS prescription pads had improved.
- Audits were in place that supported and encouraged continuous improvement, for example, an audit of patient records, use of antibiotics and taking of X-ray images.
- Management oversight in some areas of the practice required further development and improvement. For example, in the support of staff in training. Management of highly recommended training for permanent staff had improved; tools to facilitate this were now in place.
There were areas where the provider could make improvements. They should:
- Review the availability of medicines and equipment in the practice to manage medical emergencies taking into account the nationally recognised guidelines issued by the British National Formulary and the General Dental Council, and by the Resuscitation Council UK.
- Review the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term.