Updated 15 August 2019
We undertook a follow-up focused inspection of Dairyground Dental Practice on 26 June 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 Dairyground Dental Practice on 3 October 2018 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 safe and well-led care and was in breach of regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We used our enforcement powers that required the provider to take action.
We carried out a follow-up inspection on 19 March 2019 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. We found that some improvements had been made, but further work was required to ensure that care was fully safe and well-led. The provider was required to take remedial action.
You can read our reports of these previous inspections by selecting the 'all reports' link for Dairyground Dental Practice on our website www.cqc.org.uk.
As part of this inspection we asked the following questions about care and treatment provided:
• Is it safe?
• 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 inspect again after a reasonable interval, focusing on the areas where improvement was required.
Our findings were:
Are services safe?
We found this practice was not providing safe care in accordance with the relevant regulations.
The provider had made some improvements in relation to the regulatory breaches we found at our inspections of 3 October 2018 and 19 March 2019. We found that systems and processes to support safe working were not embedded.
Are services well-led?
We found this practice was not providing well-led care in accordance with the relevant regulations.
The provider had made some improvements in relation to the regulatory breaches we found at our inspections of 3 October 2018 and 19 March 2019 but had not done all that was necessary to meet the regulatory requirements.
Background
Dairyground Dental Practice is located in Bramhall, Stockport, Greater Manchester and provides NHS and some private treatment for adults and children.
The practice is not accessible for people who use wheelchairs and those with pushchairs due its access via a flight of stairs. Car parking spaces are available outside the practice, where the waiting time is limited to 90 minutes.
The dental team includes four dentists, two dental nurses, a locum dental nurse and a part-time receptionist. A practice manager works at the practice three days each week and also carries out reception duties. The practice has two treatment rooms.
The practice is owned by an individual who is the principal dentist at a sister practice. 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 the provider, two dentists, one dental nurse, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open from 8.30am to 1pm and from 2pm to 5.30pm Monday to Thursday. On Friday the practice is open from 8.30am to 1pm.
Our key findings were:
- Staff carrying out work in the decontamination room, were using appropriate personal protection equipment.
- Staff were still not examining manually cleaned instruments, before moving them to the autoclave be processed.
- We found recommendations for infection control were not embedded. We found two buckets of dirty water with mops in them, in the small decontamination room, close to the ‘clean area’, designated for packaging of dental instruments.
- Management of Legionella and practises to support this, were still not understood or executed, as per the practice risk assessment. The provider lacked oversight or understanding of this.
- Although all recruitment checks on permanent staff were now up to date, assurance of all checks on locum staff were not in place.
- Oversight of staff training had improved.
- Radiation protection information was in place, with local rules available to staff for reference. Evidence of servicing and safety checks on all radiation equipment was available.
- Arrangements for review of the fire risk assessment were in place. We saw evidence that work had been carried out on the electrics at the practice to ensure these met required standards.
- There was still no effective way for receipt, circulation, discussion and confirmation of understanding, of medical alerts and updates on clinical guidance.
- Communication across the practice, and between the and provider and staff, was not effective.
- Quality assurance processes required further work. Audits we were shown, did not contribute to learning and were not reviewed and analysed to drive improvement.
- A Statement of Purpose had still not been submitted to the Care Quality Commission.
- Leadership remained insufficient.
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.
We are taking regulatory action to impose conditions on the registration of the provider.
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 protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.