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Inspection carried out on 19 November 2019

During an inspection to make sure that the improvements required had been made

We undertook a focused inspection of Stoke Lane Dentistry on 19 November 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 Stoke Lane Dentistry on 7 August 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 19 fit and proper persons employed, 18 Staffing and 17 Good governance, 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 Stoke Lane Dentistry on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

At the last inspection we found the well-led key question was not met and we required the service to make improvements. We then inspected again after a reasonable interval, focusing on the areas where improvement was required.

Our findings were:

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

The provider had made improvements since the last inspection to put right the shortfalls we had identified. However, we found at our inspection on 19 November 2019 that there were some areas that still required improvement.

Background

Stoke Lane Dentistry is in Westbury-on-Trym, Bristol and provides NHS and private treatment for adults and children.

There is level access for one treatment room for people who use wheelchairs. There is on-street parking outside the practice.

The dental team includes three dentists; the principal dentist, a locum and a visiting dentist who carries out implant work, agency dental nurses, two dental hygienists and three receptionists. The practice has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with two dentists and the business manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 9am-5:30pm

Our key findings were:

  • The systems to manage staff training and support had improved.
  • The systems for managing risks to health and safety, fire safety, substances hazardous to health, safer sharps, incidents, X-rays, infection control, legionella, medical emergencies and prescriptions had improved.
  • The provider had improved the systems in place to ensure clinical staff had received the vaccination to protect them against the Hepatitis B virus, and that the effectiveness of the vaccination was checked.
  • The systems to ensure policies and procedures were up to date with current guidelines had improved.
  • The system for managing complaints had improved.
  • The system to ensure the Accessible Information Standard was complied with had improved.
  • The systems in place to manage how staff were safely recruited had improved. Although there were still some improvements to be made.
  • The system for monitoring referrals still needed improvement.
  • The systems in place to ensure patient dental care records included the necessary information required improvement.
  • The systems in place to manage and record information on how antibiotics were prescribed according to guidelines needed to be improved.

We identified regulations the provider was not meeting. They must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Full details of the regulation the provider was not meeting are at the end of this report.

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

  • Take action to ensure clinicians record in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.

Inspection carried out on 7 August 2019

During a routine inspection

We carried out this announced inspection on 7 August 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

Stoke Lane Dentistry is in Westbury-on-Tryme, Bristol and provides NHS and private treatment to adults and children.

There is level access for one treatment room for people who use wheelchairs and those with pushchairs. There is no practice car parking, however there is on street parking available.

The dental team includes three dentists (one of which visits the practice once a month to do implants), one trainee dental nurse, two dental hygienists and three receptionists and a business manager. The practice has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 45 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with the principal dentist, one agency trainee dental nurse, one dental hygienist, three receptionists and the business manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 9am-5:30pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. However, they had not been adequately monitored to ensure they were safe to use and available. This included the emergency oxygen and medicine to deal with low blood sugar levels.
  • The provider had ineffective systems to manage risks to patients and staff. This included health and safety, safer sharps and control of substances hazardous to health.
  • The provider safeguarding processes needed improvement, including the practice policy and monitoring of staff training in this area. The staff available to speak with knew their responsibilities for safeguarding vulnerable adults and children.
  • The provider staff recruitment procedures were ineffective and did not follow legislative requirements.
  • The clinical staff provided patients’ care and treatment in line with current guidelines.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • Staff provided preventive care and supporting patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider leadership and culture had not enabled the practice to continuously improve to ensure it was meeting current standards and processes. The business manager had been recruited in July 2019 to bring the practice forward in improving how it managed the service.
  • Staff felt involved and supported and worked well as a team.
  • The provider asked staff and patients for feedback about the services they provided. However, the results from this had not been analysed and if any changes to patient care had been made this had not been recorded.
  • The complaints policy was not up to date with current arrangements and the complaints procedure was not always followed.
  • The provider had suitable information governance arrangements.

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 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.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Ensure specified information is available regarding each person employed.

Full details of the regulations the provider 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 completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
  • Review the practice’s protocols and procedures in relation to the Accessible Information Standard to ensure that that the requirements are complied with.
  • Review the practice's complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.
  • Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
  • Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.

Inspection carried out on 8 February 2013

During a routine inspection

We spoke with three patients after they had received treatment on the day of our visit. All three of these patients were happy overall with the treatment they had received over the time they had been attending the practice. Where appropriate they had been given treatment options and the information they needed to be able to make their choice. They felt that their decisions and opinions were respected by the staff.

We found that people were given appropriate information about their treatment. Information was collected and updated about patient's medical conditions to ensure patients remained safe when being treated. Equipment was available and staff trained to deal with medical and other foreseeable emergencies. There were effective systems in place to reduce the risk and spread of infection. There was a commitment by all staff to remaining appropriately trained. A record card audit had not been undertaken to verify that patient records were compiled and maintained adequately. Patient records were stored securely.