Archived: Wilton Dental Practice

Updated 4 May 2016

We carried out an announced, comprehensive inspection on 1 December 2015. The inspection took place over one day. The inspection was led by a Care Quality Commission (CQC) inspector. They were accompanied by a dentist, specialist advisor.

Before visiting, we reviewed a range of information we hold about the practice and asked other organisations, such as NHS England and the local Healthwatch, to share what they knew about the practice. We did not receive any information of concern from Healthwatch however NHS England informed us they had concerns about the practice following their review of the practice in July 2015.

During our inspection visit, we reviewed policy documents and staff recruitment files. We spoke with three patients, four members of staff and the service provider. We conducted a tour of the practice and looked at the storage arrangements for emergency medicines and equipment. We observed the dental nurses carrying out decontamination procedures of dental instruments and also observed staff interacting with patients in the reception and waiting areas. Patients gave positive feedback about their experience at the practice.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 4 May 2016

We carried out an announced comprehensive inspection on 1 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was not 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

Wilton Dental Practice is a dental practice close to the main square in Wilton and it has three treatment rooms. The practice caters for both adults and children and provides general dentistry and some cosmetic dentistry for a mix of approximately 8,000, with 50%NHS and 50% private patients. The practice has three dental treatment rooms, a reception area and two waiting areas. There are facilities on the ground floor enabling access for patients with limited mobility. The practice offers the following services:

• Cosmetic Dentistry
• General Dentistry Treatments – including extractions
• Root canal treatments
• Oral Health promotion

The practice has two dentists and two trainee dental nurses who are supported by one receptionist. The practice opening hours are 08.45am –1.00pm and 2.00pm - 5:00pm Monday to Thursday and 08.45am –1.00pm on Friday. For out of hours service patients are directed to ring the 111 service.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered provider. 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.

We carried out an announced comprehensive inspection on 1 December 2015 because we had received information from NHS England regarding concerns about the service provided at this practice. The inspection took place over one day and was carried out by a lead inspector and a specialist dental advisor.

We obtained feedback about the practice from six completed Care Quality Commission comment cards and speaking with three patients during the inspection. The patients we spoke with were complimentary about the service. They told us they found the practice and staff provided good care; were friendly and welcoming and all patients felt they were treated with dignity and respect. Two patients told us if they had to wait for their appointments they were kept informed during the period of waiting.

Our key findings were:

• The patients we spoke with indicated they were treated with kindness and respect by staff. We observed good communication with patients and their families. Patients reported good access to the practice with emergency appointments available within 24 -48 hours.
• There were systems to check equipment had been serviced regularly, including the compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• The practice was not meeting the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' national guidance for infection prevention control in dental practices. There was no clearly designated lead professional for infection prevention and control.
• Dental nurses working in the practice lacked understanding and practical application of the minimum requirements of HTM 01-05 and the lead person for infection control had not raised with the provider or addressed the environmental shortfalls in meeting the minimum standards.
• The management of sharps was not in accordance with the current EU regulations with respect to safer sharps (Health and Safety Sharp instruments in Healthcare Regulations 2013).

• There were no systems in place to learn and improve from incidents or healthcare alerts.

• There was limited evidence of recent audits being undertaken at the dental practice.

• Appropriate recruitment processes and checks were not undertaken in line with the relevant recruitment regulations and guidance for the protection of patients.

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

• Ensure the practice fully meets the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' as soon as is practically possible.
• Ensure dental sharps are managed in accordance with the current Health and Safety Sharp instruments in Healthcare Regulations 2013 and staff are appropriately trained.
• Provide training and competency assessment for staff about infection prevention and control and ensure all processes adhere to the national guidance HTM 01-05.
• Implement a system whereby all accidents and incidents, including RIDDOR incidents, are appropriately reported and managed for the safety of patients and staff. Plan and implement a system of clinical audits as soon as practically possible for infection control, dental X-rays, clinical record keeping and other such audits as expected by the General Dental Council standards and as advised by FGDP.
• Provide clear leadership, management and governance of the practice and assess service delivery to assure the delivery of quality, patient centred treatment and care, supported by learning and innovation, and promote an open and fair culture.
• Ensure records of identification checks are included in staff recruitment files and use current DBS checks.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.