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Stanstead Road Dental Practice Limited

Inspection Summary


Overall summary & rating

Updated 14 June 2019

We carried out this announced inspection on 9 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 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

Stanstead Rd Dental Practice Limited is in the London borough of Lewisham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice for limited periods.

The dental team includes one dentist, one dental nurse, one trainee dental nurse, one dental practice manager and a company director. The practice has two treatment rooms, however, only one is currently in use.

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 Stanstead Rd Dental Practice Limited is the company director. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection received feedback from three patients.

During the inspection we spoke with the dentist, the dental nurse, the company director and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday -8.30am - 5.45pm

Tuesday-10am -7.45pm

Wednesday and Thursday -9am -5.45pm

Friday -9am -4.45pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider had infection control procedures which reflected published guidance.
  • The provider had appropriate staff recruitment procedures.
  • The provider asked patients for feedback about the services they provided.
  • The clinical staff provided patients’ care and treatment in line with current guidelines.
  • The provider had systems to deal with complaints efficiently.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • Staff treated patients with dignity and respect; however, they did not always take care to protect their privacy and personal information.
  • Staff were providing preventive care and supporting patients to ensure better oral health.
  • The appointment system did not always take into account of patients’ needs.
  • Staff did not always feel involved and supported.
  • Staff knew how to deal with emergencies. However, not all emergency medicines and life-saving equipment, was available as per national guidance.
  • There was no emergency lighting and no fire detection system in place.
  • An up to date fire risk assessment was not available. The previous risk assessment was undertaken in 2010 and not all recommendations had been completed.
  • The provider did not have suitable arrangements to ensure the safety of the X-ray equipment.
  • There were ineffective governance arrangements in place.
  • There were insufficient systems in place to manage risk to patients and staff.
  • The provider did not demonstrate effective leadership nor was there a culture of continuous improvement.

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

  • Ensure that care and treatment is provided to patients in a way that is safe
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 availability of an automated external defibrillator, (AED), in the practice to manage medical emergencies, taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council, and undertake a risk assessment if a decision is made not to have an AED on site.

Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.

Review the practice's protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection areas

Safe

Improvements required

Updated 14 June 2019

We found that this practice was not providing safe care in accordance with the relevant regulations. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report). We will be following up on our concerns to ensure they have been put right by the provider.

Staff received training in safeguarding people and knew how to recognise the signs of abuse and how to report concerns. Staff were qualified for their roles.

The practice followed national guidance for cleaning, sterilising and storing dental instruments.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals.

The provider supported staff to complete training relevant to their roles.

Equipment, including the gas boiler and the air conditioning unit was not serviced and properly maintained and five-year electrical fixed wiring checks had not been undertaken.

Medicines and equipment, as per current national guidance were not available for when dealing with medical emergencies and arrangements needed to be improved.

Fire extinguishers had been serviced in August 2018. There was no emergency lighting and no fire detection system in place.

The provider did not have suitable arrangements to ensure the safety of the X-ray equipment.

Effective

No action required

Updated 14 June 2019

We found that this practice was providing effective care in accordance with the relevant regulations.

The dentist assessed patients’ needs and provided care and treatment in line with recognised guidance. The dentist discussed treatment with patients so they could give informed consent and recorded this in their records.

Patients described the treatment they received as wonderful and professional.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals.

We saw evidence that staff completed training relevant to their roles.

Caring

No action required

Updated 14 June 2019

We found that this practice was providing caring services in accordance with the relevant regulations.

We received feedback about the practice from three people. Patients were positive about all aspects of the service the practice provided. They told us staff were friendly and pleasant.

During the inspection, we saw that staff protected patients’ privacy; however, they were not always aware of the importance of confidentiality.

Responsive

No action required

Updated 14 June 2019

We found that this practice was providing responsive care in accordance with the relevant regulations.

The practice’s appointment system did not always take into account patients’ needs and some patients were not always seen within an appropriate timescale.

Staff considered patients’ different needs. This included providing facilities for patients with a disability and families with children. The practice had access to interpreting and translation services.

The practice took patients views seriously. They valued compliments from patients and had system in place to respond to concerns appropriately.

Well-led

Enforcement action

Updated 14 June 2019

We found that this practice was not providing well-led care in accordance with the relevant regulations. We are considering our enforcement actions in relation to the regulatory breaches identified. We will report further when any enforcement action is concluded.

Governance arrangements needed to be improved. There were no systems and processes in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of services users. An up to date fire risk assessment was not available. Risk assessments for legionella and sharps had not been completed.

Systems to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activities were not in place. Infection control and radiology (X-ray) audits had not been completed.

Management structures were not clearly defined. The registered manager who was also the director, did not demonstrate effective leadership.

The practice team kept complete patient dental care records which were, clearly written or typed, however they were not always stored securely.