Archived: Stanford Dental Practice

We undertook a follow up desk-based review of Stanford Dental Practice on 11 September 2020. This review was carried out to examine 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 review was led by a CQC inspector.

We undertook a comprehensive inspection of Stanford Dental Practice on 7 October 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 regulation 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 Stanford Dental Practice on our website www.cqc.org.uk.

As part of this review we asked:

• Is it well-led?

When one or more of the five questions are not met, we require the service to make improvements and send us an action plan. We then review again after a reasonable interval, focusing on the areas where improvement was required.

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 breach we found at our inspection on 7 October 2019.

Background

Stanford Dental Practice is in Stanford Le Hope, Essex and provides approximately 99% NHS and 1% private dental treatment to adults and children.

The practice is situated on the first floor of a commercial property, access is via a steep set of stairs with a handrail, the decontamination room and staff areas are on the second floor. Car parking spaces are available in public car parks near the practice.

The dental team includes two dentists, three dental nurses, one dental hygiene therapist and one administrator, one practice manager and one cleaner. The practice has two 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 review we spoke remotely with the principal dentist and practice administrator. We looked at practice policies and procedures and other records about how the service is managed. It was noted that the practice will be relocating to new premises that are in the process of being refurbished and registered with CQC.

The practice is open: Monday to Friday from 9am to 5.30pm, the practice is open on Wednesday from 9am to 6.30pm.

Our key findings were:

• The practice had reviewed its systems to ensure good governance and effective leadership in the practice.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available and stored appropriately, these included paediatric defibrillator pads, ambu bags and masks. Glucagon (a medicine used to prevent blood glucose levels dropping too low) was stored with the medical emergencies kit with the expiry date amended to reflect storage outside of refrigeration. The fridge temperatures were monitored. Systems were in place to ensure medicines and lifesaving equipment were checked daily to ensure they were in date and in working order.
• Prescription pads were stored securely. There were systems in place to track and monitor their use.
• Staff appraisals were undertaken, the practice confirmed that personal development plans for dental staff were available at the practice.
• Systems were in place to ensure records of adequate immunity for vaccine preventable infectious diseases were available for all clinical staff.
• The practice confirmed that audits of infection prevention and control, dental care records and radiography had been completed in accordance with guidance to improve the quality of service.
• Risk assessments were undertaken to mitigate the risks associated with legionella and sharps items.
• All staff at the practice had a Disclosure and Barring Service (DBS) check recorded. A DBS log had been introduced to ensure an overview of all staff members DBS status was available.
• Five yearly fixed wire testing and annual air conditioning unit servicing had been undertaken.

• The practice confirmed that a dental nurse was available to support the dental hygienist when required.
• An electronic referral log system had been introduced in addition to the online triage system available at the practice.
• Information was recirculated to all staff regarding Clinical Health, Safety and Protection rules and the clinical staff code of dress.

• Sharps bins were dated and the external waste bin was locked and secured to the practice.
• The practice confirmed that dentists were aware of the guidelines issued by the British Endodontic Society for the use of rubber dam for root canal treatment.
• The practice had completed a disability access audit.
• The provider had risk assessments to minimise the risk that can be caused from substances that are hazardous to health.

We carried out this announced inspection on 7 October 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

Stanford Dental Practice is in Stanford Le Hope, Essex and provides approximately 99% NHS and 1% private dental treatment to adults and children.

The practice is situated on the first floor of a commercial property, access is via a steep set of stairs with a handrail, the decontamination room and staff areas are on the second floor. Car parking spaces are available in public car parks near the practice.

The dental team includes three dentists, four dental nurses, one trainee dental nurse, one dental hygiene therapist and one cleaner. The practice has two 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 102 CQC comment cards filled in by patients and staff.

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

The practice is open: Monday to Friday from 9am to 5.30pm, the practice is open on Wednesday from 9am to 6.30pm.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice staff had infection control procedures which reflected published guidance. We found the practice did not have records of six monthly infection control audits.
• Staff knew how to deal with emergencies. We noted the practice was missing some essential medical emergency equipment such as portable suction and ambubag were not available. We noted the first aid kit contents were out of date. Following the inspection, the practice sent confirmation that these had been replaced.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had arrangements to ensure the safety of the X-ray equipment.
• 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 personal information. We noted the door in one treatment room was left open when patients were receiving treatment, we were not assured all staff took care to protect patients’ privacy.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider asked staff and patients for feedback about the services they provided.
• Staff felt involved and supported and worked well as a team.

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.

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

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

• Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of rubber dam for root canal treatment.
• Implement an effective system for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
• 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.
• Implement protocols and procedures in relation to the Accessible Information Standard to ensure that that the requirements are complied with.