St Clements City Dental Care

We carried out this announced inspection on 11 March 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 Care Quality Commission (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 not 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

St Clements City Dental Care is in Farringdon, London. The practice provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes three dentists, three trainee dental nurses, and a practice manager. The dental nurses and manager undertake receptionist duties. The practice has three treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the CQC 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 St Clements City Dental Care is the principal dentist.

On the day of inspection, we collected 20 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, three dental nurses, and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday to Thursday: 9am-8pm

Friday: 9am-5pm

Our key findings were:

• The practice appeared clean and well maintained.
• Staff knew how to deal with emergencies.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had suitable information governance arrangements.
• Staff felt involved and supported.
• The provider asked staff and patients for feedback about the services they provided.
• Staff treated patients with dignity and respect.
• The provider had not established effective systems for managing incidents.
• The provider had not established effective governance systems to help them manage risks to patients and staff in relation to staff recruitment and training procedures, carrying out clinical audits, and managing complaints. They had not provided staff with sufficient information relating to reporting safeguarding concerns, making notifications to the CQC. They had not identified risks relating to the lack of some emergency equipment.
• The provider had not established a suitable protocol for monitoring outgoing referrals.
• The provider had arrangements for patients with enhanced needs, such as wheelchair users, though they had not carried out a Disability Access audit.
• The provider had infection control procedures which reflected published guidance except in relation to rinsing of instruments.
• The provider had not suitably maintained equipment and the premises relating to electrical safety, dental implants, fire safety and air conditioning.
• The provider carried out a fire risk assessment but we found it was not effective.
• The provider had carried out a Legionella Risk assessment but had not implemented actions in response to identified risks.
• The risk assessments for the Control of Substances Hazardous to Health (COSHH) required updating.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
• 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 regulations the provider was/is not meeting are at the end of this report.

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

• Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
• Review its responsibilities to respond to meet the needs of patients with disability and the requirements of the Equality Act 2010, in line with a Disability Access audit:
• Review the practice’s infection control procedures and protocols in relation to the rinsing of cleaned instruments, to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review their responsibilities as regards the COSHH Regulations 2002 and ensure all documentation is up to date and organised in such a way as to facilitate access for staff.